September 10, 2013

HHA-13-11
DC-13-11
ASC-13-12
MS-13-14

BC-13-14
SA-13-11
HP-13-11

To:

All Blue Cross and Blue Shield of Kansas Contracting Providers

From:

Connie Winkley – Education/Communication Coordinator
Institutional Provider Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association

Subject:

New Patient Discharge Status Codes on UB04 claim form effective October 1, 2013

The National Uniform Billing Committee (NUBC) was formed to develop a single billing form and standard data set that could be used nationwide by institutional providers and payers for handling health care claims.  The UB-04 Data Specifications Manual is the official source of data specifications adopted by the NUBC and contains codes used in the 837 Institutional electronic claims.

The Patient Status Code (Form Locator 17 on the UB04 claim form) identifies patient status as of statement covers through date and is required on all Institutional Inpatient and Outpatient claim types.  Electronically, the Patient Status Code is submitted in the 2300 CL103.  The NUBC has approved 16 new patient discharge codes with an effective date of October 1, 2013. 

The new codes are not replacing the old codes.  The new codes are to be used only if it is a planned acute care readmission sometime in the future.

New patient status code 69 (Discharged/transferred to a designated disaster alternative care site) will be added as a new code.  Discharge Codes 81-95 were adapted after existing codes with "a Planned Acute Care Hospital Inpatient Readmission" is appended in the title.  Readmission is defined as "An intentional readmission after discharge from an acute care hospital that is a scheduled part of the patient's plan of care."   

If you have questions regarding this newsletter or the codes listed in the table below, please contact your BCBSKS Institutional Provider Representative.  Denny Hartman can be reached at 1-316-269-1602, Cindy Garrison at 1-785-291-8862 and Janne Adams-Denton at 1-785-291-8813.

Current Code New Code Discharge Status Code Title
N/A 69 Discharged/Transferred to a designated disaster alternate care
01 81 Discharged to Home or Self Care with a Planned Acute. Care Hospital Inpatient Readmission
02 82 Discharged/Transferred to a Short Term General Hospital for Inpatient Care with a Planned Acute Care Hospital Inpatient Readmission
03 83 Discharged/Transferred to a Skilled Nursing Facility (SNF) with Medicare Certification with a Planned Acute Care Hospital Inpatient Readmission
04 84 Discharged/Transferred to a Facility that Provides Custodial or Supportive Care with a Planned Acute Care Hospital Inpatient Readmission
05 85 Discharged/transferred to a Designated Cancer Center or Children's Hospital with a Planned Acute Care Hospital Inpatient Readmission
06 86 Discharged/Transferred to Home under Care of Organized Home Health Service Organization with a Planned Acute Care Hospital Inpatient Readmission
21 87 Discharged/Transferred to Court/Law Enforcement with a Planned Acute Care Hospital Inpatient Readmission
43 88 Discharged/Transferred to a Federal Health Care Facility with a Planned Acute Care Hospital Inpatient Readmission
61 89 Discharged/Transferred to a Hospital-based Medicare Approved Swing Bed with a Planned Acute Care Hospital Inpatient Readmission
62 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
63 91 Discharged/Transferred to a Medicare Certified Long Term Care Hospital (LTCH) with a Planned Acute Care Hospital Inpatient Readmission
64 92 Discharged/Transferred to a Nursing Facility Certified Under Medicaid but not Certified Under Medicare with a Planned Acute Care Hospital Inpatient Readmission
65 93 Discharged/Transferred to a Psychiatric Hospital or Psychiatric Distinct Part Unit of a Hospital with a Planned Acute Care Hospital Inpatient Readmission
66 94 Discharged/Transferred To a Critical Access Hospital (CAR) with a Planned Acute Care Hospital Inpatient Readmission
70 95 Discharged/Transferred to Another Type of Health Care Institution not Defined Elsewhere in this Code List with a Planned Acute Care Hospital Inpatient Readmission

 

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