UB04 Field 17: Patient Discharge Status

Overview

Field 17, titled Patient Discharge Status, is a two-digit code used to identify the patient's status as of the "Through" date of the billing period [FIELD: Patient Discharge Status (Box 17)]. This field is a mandatory requirement for inpatient claims to indicate where the patient was sent or their condition at the conclusion of the hospital stay [INPATIENT: Required]. The codes range from routine discharges to home, transfers to various types of specialized medical facilities, and instances of patient expiration ^[1].

For MassHealth billing, this field is part of the standardized UB-04 claim form requirements used by acute inpatient hospitals ^[2]. While the form is used by both inpatient and outpatient facilities, the Patient Discharge Status field is specifically designated as "N/A" for outpatient services in this context [OUTPATIENT: N/A]. The codes provided in this field are essential for determining the appropriate reimbursement levels, particularly when transfers between facilities occur or when a patient is still receiving care at the time of billing [PATIENT STATUS CODES].

When to Use

The Patient Discharge Status field must be completed for all inpatient claims submitted on the UB-04 form [INPATIENT: Required]. It is used to document the final disposition of the patient at the end of the period covered by the claim [FIELD: Patient Discharge Status (Box 17)]. Providers must select the code that most accurately reflects the patient's destination or status. For example, code 01 is used for a routine discharge to home or self-care, while code 30 is used if the individual is "Still a patient" at the end of the billing cycle [PATIENT STATUS CODES].

Specific codes are required when a patient is transferred to another facility for continued care. This includes transfers to short-term general hospitals (02), skilled nursing facilities (03), or specialized centers like cancer hospitals (05) [PATIENT STATUS CODES]. Furthermore, effective October 1, 2013, a series of codes (81-94) was introduced to identify patients discharged with a "planned acute care hospital inpatient readmission," which must be used when such a follow-up stay is scheduled at the time of discharge [PATIENT STATUS CODES]. This field is not required for outpatient billing [OUTPATIENT: N/A].

Step-by-Step Claim Example

To complete Field 17 on a paper UB-04 or via the Provider Online Service Center (POSC), follow these steps based on the patient's clinical outcome ^[2]:

1. Identify the Discharge Destination: Determine where the patient went immediately following the inpatient stay. If the patient returned home without requiring organized home health services, select code 01 [PATIENT STATUS CODES].
2. Determine if a Transfer Occurred: If the patient was moved to a different type of facility, select the specific code for that facility. For instance, if the patient was transferred to a Medicare-certified Long Term Care Hospital (LTCH), enter code 63 [PATIENT STATUS CODES].
3. Check for Planned Readmissions: If the patient is being discharged to home but has a scheduled acute care readmission, do not use code 01; instead, use code 81 [PATIENT STATUS CODES].
4. Address Special Circumstances: If the patient left the facility against medical advice, enter code 07. If the patient expired in the hospital, enter code 20 [PATIENT STATUS CODES].
5. Enter the Code: Place the two-digit numeric code in Box 17 of the UB-04 form. Ensure the code aligns with the "Through" date listed in the Statement Covers Period (Box 6) [FIELD: Patient Discharge Status (Box 17)].

Common Mistakes & Audit Red Flags

One of the most frequent errors in Field 17 is the use of a discharge code when the patient has not actually been discharged. If the billing period ends but the patient remains in the facility, providers must use code 30 (Still a patient) rather than a discharge code [PATIENT STATUS CODES]. Using a discharge code like 01 while the patient is still admitted will result in claim inconsistencies during audits.

Another significant audit red flag involves the misidentification of transfer facilities. For example, using code 03 (Skilled Nursing Facility with Medicare certification) for a transfer to a facility only certified under Medicaid (which requires code 64) can lead to claim denials or payment adjustments [PATIENT STATUS CODES]. Additionally, failing to use the "planned readmission" codes (81-94) when a follow-up stay is already scheduled may be flagged during clinical reviews, as these codes have been effective since October 1, 2013 [PATIENT STATUS CODES]. Finally, providers must ensure they do not leave this field blank on inpatient claims, as it is a "Required" field for that bill type [INPATIENT: Required].

Related Codes/Fields

Field/Code	Description	Relationship to Field 17
02	Short-term general hospital	Used when the patient is transferred for acute inpatient care [PATIENT STATUS CODES].
06	Home health service	Used when discharge to home includes anticipated covered skilled care [PATIENT STATUS CODES].
20	Expired	Indicates the patient died during the inpatient stay [PATIENT STATUS CODES].
30	Still a patient	Used for interim billing when the patient remains in the facility [PATIENT STATUS CODES].
62	Inpatient Rehabilitation Facility (IRF)	Used for transfers to rehab facilities or distinct part units [PATIENT STATUS CODES].
65	Psychiatric hospital/unit	Used for transfers to psychiatric hospitals or distinct part units [PATIENT STATUS CODES].
66	Critical Access Hospital (CAH)	Used for transfers specifically to a CAH [PATIENT STATUS CODES].

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References

[1] PATIENT STATUS CODES — https://med.noridianmedicare.com/web/jea/topics/claim-submission/patient-discharge-status-codes

[2] BG-UB-04 (02/21) MassHealth Billing Guide — https://www.mass.gov/doc/ub-04-billing-guide-0/download