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Using the Correct Discharge Status Code

Published on 

Wednesday, March 23, 2022

 | Case Management 
Did You Know?

It has been over eight years since new discharge status codes (81 through 95) were finalized in the 2014 IPPS Final Rule (link).

The new codes were added to the GROUPER logic for MS-DRGs 280, 281, and 282 to identify those patients diagnosed with an acute myocardial infarction (AMI) who were discharged/transferred to another facility with a planned acute care hospital inpatient readmission alive. Following are pertinent comments from the 2014 final rule regarding these codes:

“The new discharge status codes related to a planned acute care hospital inpatient readmission were developed and approved by the National Uniform Billing Committee (NUBC) in response to a request by the provider community. The purpose of the new codes is to allow providers to track these types of situations when they occur. According to meeting notes from the NUBC, there is not a designated timeframe (or limitation) in reporting these new codes.”

“The planned readmission discharge status codes can also be reported for other MS-DRGs.”

“These new discharge status codes are not related in any way to the Hospital Readmission Reduction Program and will not be taken into account in the readmission measures for that program.”

You will find the discussion about the new codes on pages 50533 and 50534 of the 2014 IPPS Final Rule.

With these codes having been in place since October 1, 2013, I wanted to know if hospitals are using them? To find the answer, I turned to our sister company, RealTime Medicare Data (RTMD). Here is what the data revealed:

  • In FY 2021, in the RTMD database, there were 7,898,214 Medicare Fee-for-Service acute inpatient hospital paid claims.
  • Of those claims, 12,146 included one of the discharge status codes that includes a planned readmission.
  • The top five discharge status codes with a planned readmission by volume were:
    • 2,307 claims included discharge status code 81 (Discharged to home or self-care with a planned acute care hospital inpatient readmission),
    • 2,185 claims included discharge status code 83 (Discharged/transferred to a skilled nursing facility (SNF) with Medicare certification with a planned acute care hospital inpatient readmission,
    • 1,873 claims included discharge status code 90 (Discharged/transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital with a planned acute care hospital inpatient readmission,
    • 1,602 claims included discharge status code 86 (Discharged/transferred to home under care of organized home health service organization with a planned acute care hospital inpatient readmission), and
    • 1,437 claims included discharge status code 82 (Discharged/transferred to a short-term general hospital with a planned acute care hospital inpatient readmission.
    • Top five states using discharge status codes with a planned readmission:
      • Florida – 1,281 claims
      • Texas – 1,140 claims
      • Pennsylvania – 918 claims
      • New York - 884 claims
      • California – 760 claims
    • Bottom five states using discharge status codes with a planned readmission:
      • Arkansas – 13 claims
      • Ohio – 7 claims
      • Vermont – 5 claims
      • Hawaii – 3 claims
      • Hawaii – 3 claims
Why It Matters?

Assigning the correct discharge status code is important and can be costly if not correct.

The Comprehensive Error Rate Testing (CERT) A/B Medicare Administrative Contractor (MAC) Outreach & Education Task Force has published an education resource titled Patient Discharge Status Codes Matter (link). In this document, the CERT contractor notes they have issued errors related to the incorrect use of Discharge Status Codes that may result in an overpayment or underpayment of Medicare claims.

Incorrect discharge status codes can also cause an admitting facility to not be able to be paid due to the incorrect billing of the acute inpatient hospital.

What Can You Do?

A patient’s discharge disposition can change after the patient has already discharged from your hospital. The CERT contractor encourages hospitals “to follow-up with the patient after discharge and prior to submitting the claim to Medicare to ensure the patient went to the planned facility that was recorded in the medical record. This will prevent incorrect billing of the Discharge Status Code and avoid unnecessary adjustments to claims when the incorrect code is used.”

I encourage you to read the CERT Task Force document as well as the listed resources on this document to help prevent improper payments due to incorrect billing of discharge status codes.

Additional Resource:

MLN SE21001 Review of Hospital Compliance with Medicare’s Transfer Policy with the Resumption of Home Health Services & Other Information on Patient Discharge Status Codes (link)
Article Author: Beth Cobb, RN, BSN, ACM, CCDS
Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Protection Assessment Tool.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.