Patient Discharge Status Code

Short SAS Name: 
STUS_CD

The code used to identify the status of the patient as of the CLM_THRU_DT.

Codes: 
CodeCode value
01
Discharged to home/self care (routine charge).
02
Discharged/transferred to other short term general hospital for inpatient care.
03
Discharged/transferred to skilled nursing facility (SNF) with Medicare certification in anticipation of covered skilled care -- (For hospitals with an approved swing bed arrangement, use Code 61 - swing bed. For reporting discharges/transfers to a non-certified SNF, the hospital must use Code 04 - ICF.
04
Discharged/transferred to intermediate care facility (ICF).
05
Discharged/transferred to another type of institution for inpatient care (including distinct parts). NOTE: Effective 1/2005, psychiatric hospital or psychiatric distinct part unit of a hospital will no longer be identified by this code. New code is '65'
06
Discharged/transferred to home 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. (discontinued effective 10/1/05)
09
Admitted as an inpatient to this hospital (effective 3/1/91). In situations where a patient is admitted before midnight of the third day following the day of an outpatient service, the outpatient services are considered inpatient.
20
Expired (did not recover - Christian Science patient).
30
Still patient.
40
Expired at home (hospice claims only)
41
Expired in a medical facility such as hospital, SNF, ICF, or freestanding hospice. (Hospice claims only)
42
Expired - place unknown (Hospice claims only)
43
Discharged/transferred to a federal hospital (eff. 10/1/03)
50
Hospice - home (eff. 10/96)
51
Hospice - medical facility (eff. 10/96)
61
Discharged/transferred within this institution to a hospital-based Medicare approved swing bed (eff. 9/01)
62
Discharged/transferred to an inpatient rehabilitation facility including distinct parts units of a hospital. (eff. 1/2002)
63
Discharged/transferred to a long term care hospitals. (eff. 1/2002)
64
Discharged/transferred to a nursing facility certified under Medicaid but not under Medicare (eff. 10/2002)
65
Discharged/Transferred to a psychiatric hospital or psychiatric distinct unit of a hospital (these types of hospitals were pulled from patient/discharge status code '05' and given their own code). (eff. 1/2005).
66
Discharged/transferred to a Critical Access Hospital (CAH) (eff. 1/1/06)
70
Discharged/transferred to another type of health care institution not defined elsewhere in code list.
71
Discharged/transferred/referred to another institution for outpatient services as specified by the discharge plan of care (eff. 9/01) (discontinued effective 10/1/05)
72
Discharged/transferred/referred to this institution for outpatient services as specified by the discharge plan of care (eff. 9/01) (discontinued effective 10/1/05)
EXPLANATION OF CLAIM ADJUSTMENT GROUP CODES POSITIONS 1 & 2 OF ANSI CODE
CodeCode value
CO
Contractual Obligations -- this group code should be used when a contractual agreement between the payer and payee, or a regulatory requirement, resulted in an adjustment. Generally, these adjustments are considered a write-off for the provider and are not billed to the patient.
CR
Corrections and Reversals - this group code should be used for correcting a prior claim. It applies when there is a change to a previously adjudicated claim.
OA
Other Adjustments - this group code should be used when no other group code applies to the adjustment.
PI
Payer Initiated Reductions -- this group code should be used when, in the opinion of the payer, the adjustment is not the responsibility of the patient, but there is no supporting contract between the provider and the payer (i.e., medical review or professional review organization adjustments).
PR
Patient Responsibility - this group should be used when the adjustment represents an amount that should be billed to the patient or insured. This group would typically be used for deductible and copay adjustments.
CodeCode value
1
Deductible Amount
2
Coinsurance Amount
3
Co-pay Amount
4
The procedure code is inconsistent with the modifier used or a required modifier is missing.
5
The procedure code/bill type is inconsistent with the place of service.
6
The procedure code is inconsistent with the patient's age.
7
The procedure code is inconsistent with the patient's gender.
8
The procedure code is inconsistent with the provider type.
9
The diagnosis is inconsistent with the patient's age.
10
The diagnosis is inconsistent with the patient's gender.
11
The diagnosis is inconsistent with the procedure.
12
The diagnosis is inconsistent with the provider type.
13
the date of death precedes the date of service.
14
The date of birth follows the date of service.
15
Claim/service adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider.
16
Claim/service lacks information which is needed for adjudication.
17
Claim/service adjusted because requested information was not provided or was insufficient/incomplete.
18
Duplicate claim/service.
19
Claim denied because this is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier.
20
Claim denied because this injury/illness is covered by the liability carrier.
21
Claim denied because this injury/illness is the liability of the no-fault carrier.
22
Claim adjusted because this care may be covered by another payer per coordination of benefits.
23
Claim adjusted because charges have been paid by another payer.
24
Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan.
25
Payment denied. Your Stop loss deductible has not been met.
26
Expenses incurred prior to coverage.
27
Expenses incurred after coverage terminated.
28
Coverage not in effect at the time the service was provided.
29
The time limit for filing has expired.
30
Claim/service adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements.
31
Claim denied as patient cannot be identified as our insured.
32
Our records indicate that this dependent is not an eligible dependent as defined.
33
Claim denied. Insured has no dependent coverage.
34
Claim denied. Insured has no coverage for newborns.
35
Benefit maximum has been reached.
36
Balance does not exceed copayment amount.
37
Balance does not exceed deductible amount.
38
Services not provided or authorized by designated (network) providers.
39
Services denied at the time authorization/pre-certification was requested.
40
Charges do not meet qualifications for emergency/urgent care.
41
Discount agreed to in Preferred Provider contract.
42
Charges exceed our fee schedule or maximum allowable amount.
43
Gramm-Rudman reduction.
44
Prompt-pay discount.
45
Charges exceed your contracted/legislated fee arrangement.
46
This (these) service(s) is(are) not covered.
47
This (these) diagnosis(es) is(are) not covered, missing, or are invalid.
48
This (these) procedure(s) is(are) not covered.
49
These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam.
50
These are non-covered services because this is not deemed a 'medical necessity' by the payer.
51
These are non-covered services because this a pre existing condition.
52
The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed.
53
Services by an immediate relative or a member of the same household are not covered.
54
Multiple physicians/assistants are not covered in this case.
55
Claim/service denied because procedure/treatment is deemed experimental/investigational by the payer.
56
Claim/service denied because procedure/treatment has not been deemed 'proven to be effective' by payer.
57
Claim/service adjusted because the payer deems the information submitted does not support this level of service, this many services, this length of service, or this dosage.
58
Claim/service adjusted because treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.
59
Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules.
60
Charges for outpatient services with the proximity to inpatient services are not covered.
61
Charges adjusted as penalty for failure to obtain second surgical opinion.
62
Claim/service denied/reduced for absence of, or exceeded, precertification/authorization.
63
Correction to a prior claim. INACTIVE
64
Denial reversed per Medical Review. INACTIVE
65
Procedure code was incorrect. This payment reflects the correct code. INACTIVE
66
Blood Deductible.
67
Lifetime reserve days. INACTIVE
68
DRG weight. INACTIVE
69
Day outlier amount.
70
Cost outlier amount.
71
Primary Payer amount.
72
Coinsurance day. INACTIVE
73
Administrative days. INACTIVE
74
Indirect Medical Education Adjustment.
75
Direct Medical Education Adjustment.
76
Disproportionate Share Adjustment.
77
Covered days. INACTIVE
78
Non-covered days/room charge adjustment.
79
Cost report days. INACTIVE
80
Outlier days. INACTIVE
81
Discharges. INACTIVE
82
PIP days. INACTIVE
83
Total visits. INACTIVE
84
Capital adjustments. INACTIVE
85
Interest amount. INACTIVE
86
Statutory adjustment. INACTIVE
87
Transfer amounts.
88
Adjustment amount represents collection against receivable created in prior overpayment.
89
Professional fees removed from charges.
90
Ingredient cost adjustment.
91
Dispensing fee adjustment.
92
Claim paid in full. INACTIVE
93
No claim level adjustment. INACTIVE
94
Process in excess of charges.
95
Benefits adjusted. Plan procedures not followed.
96
Non-covered charges.
97
Payment is included in allowance for another service/procedure.
98
The hospital must file the Medicare claim for this inpatient non-physician service. INACTIVE
99
Medicare Secondary Payer Adjustment Amount. INACTIVE
100
Payment made to patient/insured/responsible party.
101
Predetermination: anticipated payment upon completion of services or claim ajudication.
102
Major medical adjustment.
103
Provider promotional discount (i.e. Senior citizen discount).
104
Managed care withholding.
105
Tax withholding.
106
Patient payment option/election not in effect.
107
Claim/service denied because the related or qualifying claim/service was not paid or identified on the claim.
108
Claim/service reduced because rent/purchase guidelines were not met.
109
Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.
110
Billing date predates service date.
111
Not covered unless the provider accepts assignment.
112
Claim/service adjusted as not furnished directly to the patient and/or not documented.
113
Claim denied because service/procedure was provided outside the United States or as a result of war.
114
Procedure/PRODuct not approved by the Food and Drug Administration.
115
Claim/service adjusted as procedure postponed or canceled.
116
Claim/service denied. The advance indemnification notice signed by the patient did not comply with requirements.
117
Claim/service adjusted because transportation is only covered to the closest facility that can provide the necessary care.
118
Charges reduced for ESRD network support.
119
Benefit maximum for this time period has been reached.
120
Patient is covered by a managed care plan. INACTIVE
121
Indemnification adjustment.
122
Psychiatric reduction.
123
Payer refund due to overpayment. INACTIVE
124
Payer refund amount - not our patient. INACTIVE
125
Claim/service adjusted due to a submission/billing error(s).
126
Deductible - Major Medical.
127
Coinsurance - Major Medical.
128
Newborn's services are covered in the mother's allowance.
129
Claim denied - prior processing information appears incorrect.
130
Paper claim submission fee.
131
Claim specific negotiated discount.
132
Prearranged demonstration project adjustment.
133
The disposition of this claim/service is pending further review.
134
Technical fees removed from charges.
135
Claim denied. Interim bills cannot be processed.
136
Claim adjusted. Plan procedures of a prior payer were not followed.
137
Payment/Reduction for Regulatory Surcharges, Assessments, Allowances or Health Related Taxes.
138
Claim/service denied. Appeal procedures not followed or time limits not met.
139
Contracted funding agreement - subscriber is employed by the provider of services.
140
Patient/Insured health identification number and name do not match.
141
Claim adjustment because the claim spans eligible and ineligible periods of coverage.
142
Claim adjusted by the monthly Medicaid patient liability amount.
A0
Patient refund amount
A1
Claim denied charges.
A2
Contractual adjustment.
A3
Medicare Secondary Payer liability met. INACTIVE
A4
Medicare Claim PPS Capital Day Outlier Amount.
A5
Medicare Claim PPS Capital Cost Outlier Amount.
A6
Prior hospitalization or 30 day transfer requirement not met.
A7
Presumptive Payment Adjustment.
A8
Claim denied; ungroupable DRG.
B1
Non-covered visits.
B2
Covered visits. INACTIVE
B3
Covered charges. INACTIVE
B4
Late filing penalty.
B5
Claim/service adjusted because coverage/program guidelines were not met or were exceeded.
B6
This service/procedure is adjusted when performed/billed by this type of provider, by this type of facility, or by a provider of this specialty.
B7
This provider was not certified/eligible to be paid for this procedure/service on this date of service.
B8
Claim/service not covered/reduced because alternative services were available, and should have been utilized.
B9
Services not covered because the patient is enrolled in a Hospice.
B10
Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test.
B11
The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor.
B12
Services not documented in patients' medical records.
B13
Previously paid. Payment for this claim/service may have been provided in a previous payment.
B14
Claim/service denied because only one visit or consultation per physician per day is covered.
B15
Claim/service adjusted because this procedure/service is not paid separately.
B16
Claim/service adjusted because 'New Patient' qualifications were not met.
B17
Claim/service adjusted because this service was not prescribed by a physician, not prescribed prior to delivery, the prescription is incomplete, or the prescription is not current.
B18
Claim/service denied because this procedure code/modifier was invalid on the date of service or claim submission.
B19
Claim/service adjusted because of the finding of a Review Organization. INACTIVE
B20
Charges adjusted because procedure/service was partially or fully furnished by another provider.
B21
The charges were reduced because the service/care was partially furnished by another physician. INACTIVE
B22
This claim/service is adjusted based on the diagnosis.
B23
Claim/service denied because this provider has failed an aspect of a proficiency testing program.
W1
Workers Compensation State Fee Schedule Adjustment.