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September 2009 Provider Bulletin Number 985
Hospital Providers
New and Revised Patient Discharge Status Codes
Effective with discharge dates on or after October 1, 2009, a new patient discharge status code
(21) was added to define discharges or transfers to court/law enforcement. Patient discharge
status code 21 usage includes transfers to incarceration facilities such as jails, prisons, or other
detention facilities.
Effective with discharge dates on or after October 1, 2009, existing patient status codes 01
and 04 have been revised.
• 01 Discharged to home or self care (routine discharge)
Usage revision: excludes jail or law enforcement
• 04 Discharged/transferred to a facility that provides custodial or supportive care
Changed from discharged/transferred to an intermediate care facility
Information about the KHPA Medical Plans as well as provider manuals and other publications are available at
https://www.kmap-state-ks.us. For the changes resulting from this provider bulletin, please view the Hospital
Provider Manual, Section 7000, pages 7-3 and 7-4.
If you have any questions, please contact Customer Service at 1-800-933-6593 (in-state providers) or
785-274-5990 between 7:30 a.m. and 5:30 p.m., Monday through Friday.
EDS is the fiscal agent and administrator of the KHPA Medical Plans.
Page 1 of 3
7000. Updated 09/09
A – Reserved for assignment by NUBC
B – Transfer from another home health facility
C – Readmission to same home health agency
D – Transfer from one distinct unit of the hospital to another distinct
unit of the same hospital resulting in separate claim to the payer
E – Transfer from ambulatory surgery center
F – Transfer from hospice and is under a hospice plan of care or
enrolled in a hospice program
G-Z – Reserved for assignment by NUBC
Code structure for newborn
1-4 – Reserved
5 – Born inside this hospital
6 – Born outside of this hospital
7-9 – Reserved
FL 16 Discharge Hour – Required on inpatient claims with a frequency code of
1 or 4 except Type of Bill 021X.
FL 17 Patient Status - Required - Inpatient Only. Enter a two-digit code to
indicate status of patient:
01 Discharged to home or self care (routine discharge)
02 Discharged/transferred to another short-term general hospital for
inpatient care
03 Discharged/transferred to skilled nursing facility (SNF) with Medicare
certification
04 Discharged/transferred to a facility that provides custodial or
supportive care an Intermediate Care Facility (ICF)
05 Discharge/transfer to a designated cancer center or children’s hospital
06 Discharged/transferred to a home under care of organized home health
service organization
07 Left against medical advice or discontinued care
08 Discharged/transferred to home under care of a home IV drug therapy
provider (This is not a certified Medicare provider.)
09 Admitted as an inpatient to this hospital (for use on Medicare
Outpatient Hospital claims only)
20 Expired (or did not recover - Christian Science Patient)
21 Discharged/transferred to court/law enforcement
30 Still patient
40 Expired at home (Hospice claims only)
41 Expired in a medical facility, such as a hospital, SNF, ICF, or
freestanding hospice (Hospice claims only)
42 Expired - place unknown (Hospice claims only)
43 Discharge/transferred to a Federal Health Care Facility
50 Discharge to hospice – home
51 Discharge to hospice - medical facility.
KANSAS MEDICAL ASSISTANCE PROGRAM
HOSPITAL PROVIDER MANUAL
BILLING INSTRUCTIONS
7-3
7000. Updated 09/09
61 Discharged/transferred within this institution to a hospital-based,
Medicare-approved, swing bed
62 Discharged/transferred to another rehabilitation facility an inpatient
rehabilitation facility (IRF) including rehabilitation distinct part units
of a hospital
63 Discharged/transferred to a Medicare certified long term care hospital
(LTCH)
64 Discharged/transferred to a nursing facility certified under Medicaid
but not certified under Medicare
65 Discharged/transferred to a psychiatric hospital or psychiatric distinct
part unit of a hospital
66 Discharged/transferred to a Critical Access Hospital (CAH) for
discharge dates on or after January 1, 2006
70 Discharged/transferred to another type of health care institution not
defined elsewhere in the code list
Note: Hospitals will be eligible for full DRG reimbursement when a discharge
occurs using discharge code 01, 03, 04, 05, 06, 07, 08, 20, 50, or 51.
Distinct claim forms must be submitted for each discharge. In the case of
transfers to same specialty providers (discharge code 02), the transferring
hospital’s reimbursement may be reduced, based upon a transfer prorated
reimbursement determination, and the receiving hospital will be eligible to
receive a full DRG reimbursement.
FL 18-28 Condition Codes – Enter one of these two-digit codes to indicate a
condition(s) relating to inpatient or outpatient claims, special programs or
procedures (e.g., KAN Be Healthy, sterilization)
Note: This is not a complete list. For a complete list of Condition Codes
contact Customer Service.
01 Military service related
02 Condition is employment related
03 Patient covered by insurance not reflected here
67 Beneficiary elects not to use life time reserve (LTR) days
Note: This will now replace the Z1 Medicare Part A benefits exhausted
condition code. The verbiage in the explanation of condition code 67
means the patient’s benefits are exhausted.
80 Home Dialysis – Nursing Facility
A1 KAN Be Healthy (EPSDT)
A4 Family Planning
AA Abortion performed due to rape
AB Abortion performed due to incest
AI Sterilization
D9 Any other change
Note: This will now replace the XO swing bed condition code.
KANSAS MEDICAL ASSISTANCE PROGRAM
HOSPITAL PROVIDER MANUAL
BILLING INSTRUCTIONS
7-4
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