2011 nubc manual discharge status codes

Because this data element is critical in determining the population for many measures, the abstractor should not assume that the ub04 value is what is reflected in the medical record. Patient discharge status codes and hospital transfer policies. Sep 2, 2012 center clc admission criteria, service codes, and discharge. This table indicates how to crosswalk the new nubc. All inpatient discharges including psychiatric andor behavioral health, rehabilitation. Ub 04 medicare discharge status code cms 1500 claim form. A ub04 with field descriptions and instructions is included in the link below. Any nubc approved patient status code may be used in these cases. Dischargedtransferred to a nursing facility certified under medicaid but not certified under medicare. The following changes have been made by the national uniform billing committee nubc and are outlined below. Fl 16 discharge hour 35 fl 17 patient discharge status 36 fl 1828 condition codes 48 fl 29 accident state 61 fl 30 reserved for assignment by the nubc 62 fl 34 occurrence codes and dates 63 fl 3536 occurrence span codes and dates 71 fl 37.

Making copies or utilizing the content of the ub04 manual or ub04 data file, including the codes andor descriptions, for internal purposes. Apr 1, 2004 national uniform billing committee nubc and to add all nubc additionally, all codes that have been approved by the nubc and that se1117 cms. Jan 07, 2016 patient discharge status codes are part of the official ub04 data specifications manual and are used nationwide by institutional, private, and public providers, and payers of health care claims. Since this is a discharge to outpatient treatment, and it is expected that the patient will go home afterward, use discharge status 01, discharged to home or self care. The national uniform billing committee nubc has approved the. Patient discharge status code reporting a discharge occurs when a medicare beneficiary leaves an acute care hospital after receiving acute care treatment. Racs and patient status, discharge disposition codes part. A patient discharge status code is a twodigit code that identifies where the patient is at the conclusion of a health care facility encounter or at the end of a billing cycle the through date of a claim. Point of origin code 6 transfer from another health care facility not defined elsewhere in this code list patient status code 69 dischargedtransferred to a designated disaster alternative care site. The new codes are to be used only if it is a planned acute. In 2011 12 chars transitioned to the 837 5010 file format and october 1, 2014 with the united states will move to icd10 codes.

Nicu level of care criteria blue shield of california. A patient discharge status code is a twodigit code that identifies where the patient is at the conclusion of a health care facility encounter or at the end of. Ub04 billing instructions guide health pas online maine. Nubc voted to accept the ub82 and its associated data manual for implementation as a. West virginia hospital inpatient data system data element specifications guide february 7, 2011 page 1 introduction the west virginia hospital inpatient data system wvhids collects, processes, and analyzes inpatient discharge data that are collected by the west virginia health care authority wvhca. If a patient is discharged from an acute care hospital to a medicarecertified swing bed in a snf, is the discharge status of 03 correct, or should it be 61.

Locator 15 point of origin for admission or visit previously known as source of admission. Mar 15, 2017 is located in the medicare claims processing manual 4, chapter clarification on the proper usage of patient discharge status codes, 2017 icd10cm guidelines centers for disease control and. Masshealth billing guide for the ub04 executive office of. This manual, ed by the american hospital association, is the only official source of ub data. A patient discharge status code is a twodigit code entered into form locator fl 17 on the ub04 claim form that identifies the patients status at the conclusion of a health care facility encounter this could be a visit or an actual inpatient stay or at the time end of a billing cycle the through date of a. Technical assistance conference call hrsarhcclaims5010. Joint commission discharge disposition discharged to home, home health or. It is a refresher from the provider billing manual. Locator 17 patient discharge status 01 discharged 30 still patient locator 38 responsible. Many types of providers use the ub04 claim form to. Some fields have been have been changed or codes have been added or deleted for existing fields.

Patient discharge status codes identify where a patient is at the conclusion of a health care facility encounter or at the end of a billing cycle. Jan 05, 2015 nubc meeting march 12, 2011 hilton garden inn chicago mar 1, 2011 line item dates on inpatient claims nubc and dsmo crs 1. As the health care industry prepared for hipaa implementation, it. The chars procedure manual and chars companion guide supplement the national uniform billing committee uniform billing form 2004 nubc ub04 and the asc x12. Health care dme medicaid hmo amendment effective november 1, 20. Sep 27, 20 effective october 1, 20, nubc approved sixteen 16 new discharge status codes patient disposition. Locator 16 discharge hour required on inpatient claims with a frequency code of 1 or 4 last digit of bill type. National uniform billing committee nubc uniform bill. See appendix a for a partial list of the patients discharge status codes and more information on the complete list. Changes to the manual from 2011 through 2017 numerous and significant changes have been made to the ub04 manual from 2011 through 2017.

Patient assessment information is collected on admission, at discharge and death. September 20 anthem sep 2, 20 20 national uniform billing committee nubc ub04 code changes. Committee nubc has approved new discharge status codes 8195 that go into effect with october. Aarp health insurance plans pdf download medicare replacement pdf download aarp medicarerx plans united healthcare pdf download medicare benefits pdf download. Status are taken from the national uniform billing committee nubc manual which is. New patient discharge status codes on ub04 claim form. The national uniform billing committee nubc ballots and maintains these condition codes as part of the nubc universal billing ub code set, which is an external code set requests for new codes or modification of codes may be submitted through the nubc web site at. Instead, the hospice reports condition code h2 to indicate a discharge for cause.

When the status is a discharged on the through date of service, the through date is not included in the calculation of the number of days. Nubc patient status ub04 data specifications manual. Clarification of patient discharge status codes and hospital transfer policies ja0801. The ltchcare data set is the assessment instrument used for all patients receiving inpatient services in a facility certified as a hospital and designated as a ltch under the medicare program. Data element dictionary and ncpdp ncpdp october 2011 data dictionary. The patient discharge status codes listed below is not an allinclusive list. Most common payer idhealth plan id numbers naic codes. Aarp health insurance plans pdf download medicare replacement pdf download.

The nubc has approved 16 new patient discharge codes with an effective date of october 1, 20. The provider enters the code indicating the source of the referral. When the patient status is 30 still a patient, the through date is included in the calculation of days. The values for discharge status are taken from the national uniform billing committee nubc manual which is used by the billinghim to complete the ub04. A note was added to require occurrence code 55 to be reported with discharge status 20 to indicate the patients date vha hbk 1142. The hospice does not report occurrence code 42 on their claim. Patient discharge status code reporting a discharge occurs when a. You can access the ub04 billing information adopted by the nubc by subscribing to the official ub04 data specifications manual. National uniform billing committee, american hospital association. The code usage includes transfers to incarceration facilities such as jail, prison or other detention facilities. This is the second article by gloryanne bryant on a subject that continues to raise questions and cause confusion.

New patient discharge status codes type of bills tob 32x and 34x. Clarification of patient discharge status codes and hospital. In the case of a discharge for cause, the hospice uses the nubc approved discharge status code that best describes the beneficiarys situation. A patient is discharged from our facility disposition code 01 and is to go to a doctors appointment the same day. Manual by permission, copyright 2011, by american hospital association. The purpose of the tob chart in the manual to help guide hipaa users nubc billing alert national uniform billing committee nov 17, 2010. For claims involving patients transferred to or originating from designated disaster alternate care sites, the following codes are applicable. Ja0801 was revised to update the web address on page 3 for accessing the list of designated cancer. Hospitals and providers are manual, appendix a survey protocol, regulations and interpretive guidelines for national uniform billing committee nubc, effective april 1, 2004, that specifies. For status codes, please refer to the nubc ub04 manual.

Ub04 discharge status codes a patient discharge status code is a twodigit code entered into form locator fl 17 on the ub04 claim form that identifies the patients status at the conclusion of a health care facility encounter this could be a visit or an actual inpatient stay or at the time end of a billing cycle the through date of a. Mar 15, 2017 clarification of patient discharge status codes and hospital transfer policies information on the inpatient transfer policy is located in the clarification of patient discharge status codes. Up to 22 revenue codes and associated charges may be entered on each ub04 claim form. Fl 17 patient discharge status 49 fl 1828 condition codes 65 fl 29 accident state 81 fl 30 reserved for assignment by the nubc 82 fl 34 occurrence codes and dates 83 fl 3536 occurrence span codes and dates 92 fl 37 reserved for assignment by the nubc 96 fl 38 responsible party name and address claim addressee 97 fl 3941. Refer to the nubc instruction manual for code values.

Dataelem0247 manual performance measurement network. Hospital discharge data system user manual august 2018 7 numerous and significant changes have been made to the ub04 manual from 2011 through 2018. The national uniform billing committee nubc created a new patient discharge code to define discharges or transfers to courtlaw enforcement. National uniform billing committee nubc official ub04 data specifications manual. Some fields have been changed, or codes have been added or deleted for existing fields. Committee nubc has provided clarified direction on the patients or visit codes 1, 2, or 5 are reported. Nubc clarified the following hospice levels of care. Electronically, the patient status code is submitted in the 2300 cl103. Committee nubc payer only codes to the medicare claims processing manual, chapter 1 value. Medicare 75 general instructions for completion of form cms1450 for billing. Refer to the national uniform claim committee nubc instruction manual available at. Dec 11, 2019 apr 1, 2004 national uniform billing committee nubc and to add all nubc additionally, all codes that have been approved by the nubc and that se1117 cms.

Assigning the correct patient discharge status code is just as important as any other. Manual ub04 fl17 patient status codes dischargedtransferred to a. For hospitals with an approved swing bed arrangement, use code 61swing bed. The data elements and codes are developed and maintained by the national uniform billing committee nubc. The new codes are to be used only if it is a planned acute care readmission sometime in the future. Enter the patients 2digit status at the end of the period covered by this bill through discharge always include both digits. In this instance, what should the correct discharge status code be on this patient. The purpose of the tob chart in the manual to help guide hipaa users nubc billing alert national uniform billing committee nov 17, 2010 billing alert. Clarification of patient discharge status codes and hospital cms. Clarification of patient discharge status codes and cms. Apr 28, 2011 search for the rhc billing manual for revenue code 0900 from both rhcs.

Nubc official ub04 data specifications manual 2017 version 2. Clarification of patient discharge status codes and. Fl 16 discharge hour 35 fl 17 patient discharge status 36 fl 1828 condition codes 48 fl 29 accident state 61 fl 30 reserved for assignment by the nubc 62 fl 34 occurrence codes and dates 63 fl 3536 occurrence span codes and dates 71 fl 37 reserved for assignment by the nubc 74. It is important to select the correct patient discharge status code because it may affect your payment. To report hh visits on episodes beginning on or after january 1, 2011, the hha. No other publication governmental or privatecommercial can be considered authoritative. Ub04 data specifications manual and the centers for medicare and medicaid services cms international classification of diseases, ninth revision, clinical modification icd9cm official guidelines for coding and reporting. The nubc data specifications manual provides documentation and further guidance to assistin determining the proper patient discharge status code to use based on the patients status when completing the claim.

Jul 29, 2011 is received with any discharge status code other than 30. Origin for admission or visit codes to the ub04 cms1450 manual code list. Nubc meeting march 12, 2011 hilton garden inn chicago mar 1, 2011 line item dates on inpatient claims nubc and dsmo crs 1. National uniform billing committee nubc uniform bill patient discharge status codes provides a set of patient status codes used for patient billing to be included in discharge status messages. Racs and patient status, discharge disposition codes part ii. Enter the appropriate twocharacter condition codes. New patient discharge status codes fl17 approved by nubc effective. The national uniform billing committee nubc approved a new patient discharge status code 20 expired, 40 expired at home, 41 expired in a change request 7473 cms. If the facility has some medicare certified beds you should use patient status code 03 or 04 depending on the level of care the patient is receiving and if they are placed in a medicare certified bed or not. Admission type code 9 and admission source code 9 are not allowed. Yes, there is guidance available from nubc that offers a variety of scenarios with answers to questions about patient status code accuracy. The fl 59a, b, and c patients relationship to insured. Accordingly, the centers for mln matters article se0801 cms.