UB04 Field 17: Patient Discharge Status

Overview

Field 17: Patient Discharge Status is a two-digit code used to identify the patient's destination or status at the conclusion of a healthcare encounter or at the end of a specific billing period. Located on the right side of the UB-04 claim form, this field is mandatory for all inpatient claims and specific outpatient encounters, such as those involving Home Health or Hospice. The National Uniform Billing Committee (NUBC) maintains these codes to ensure standardized reporting across all institutional payers.

This field is critical for determining payment accuracy under the Inpatient Prospective Payment System (IPPS). It directly impacts the calculation of the Diagnosis Related Group (DRG) payment. If a patient is transferred to another acute care setting or a post-acute facility (like an SNF or IRF), the original hospital may receive a per-diem rate rather than the full DRG payment under the Post-Acute Care Transfer (PACT) policy CMS Pub. 100-04 Chapter 3.

When to Use This Field

Field 17 must be populated on every inpatient claim (Type of Bill 11X) and for outpatient claims where the patient’s status changes, such as Home Health (32X) or Hospice (81X/82X). It captures the patient's disposition at the exact moment of discharge.

Scenario 1: Post-Acute Transfer A patient is treated for a hip fracture at an acute care hospital. After five days, the patient is stable but requires intensive physical therapy. The hospital transfers the patient to a Skilled Nursing Facility (SNF). The biller must use Code 03 (Discharged/transferred to an SNF with Medicare certification). Using Code 01 (Home) in this scenario would trigger an audit if the SNF later submits a claim for the same patient Medicare Claims Processing Manual.

Scenario 2: Interim Billing In cases of long-term hospitalizations exceeding 30 days, facilities may submit "interim" claims to maintain cash flow. If the patient is still receiving care at the end of the billing period, the biller uses Code 30 (Still a patient). This signals to the payer that the encounter is ongoing and a final discharge claim will follow.

Step-by-Step Claim Example

Patient Scenario: A 72-year-old Medicare beneficiary is admitted to "City General Hospital" for acute respiratory failure. After a 10-day stay, the patient is discharged. However, the patient requires ongoing wound care and physical therapy at home, so the hospital coordinates with a certified Home Health Agency (HHA).

Field Values:

• Field 04 (Type of Bill): 111 (Inpatient Hospital - Admit through Discharge)
• Field 06 (Statement Covers Period): 010124 to 011024
• Field 17 (Status): 06 (Discharged to home under care of organized home health service)
• Field 42 (Revenue Code): 0120 (Room & Board)

Payer Response: Medicare processes the claim under the IPPS. Because Code 06 is used, the system checks for a matching HHA claim within three days of the hospital discharge. If the hospital incorrectly billed Code 01 (Routine Discharge) but the HHA billed for services starting the next day, Medicare would identify a "Transfer" conflict. The hospital's full DRG payment would be adjusted to a per-diem rate to prevent overpayment under the PACT policy CMS Post-Acute Care Transfer Policy.

Common Mistakes & Audit Red Flags

• Miscoding Routine Discharge (01) vs. Home Health (06): This is the most frequent error. If a discharge plan includes HHA services, Code 06 must be used. Payers perform "Post-Payment Reviews" by matching hospital claims against HHA claims. If a match is found and the hospital used Code 01, the payer will recoup the overpayment.
• Incorrect Use of Code 02 (Short-term Hospital): Billers often use Code 02 when a patient is moved to a different unit within the same facility. Code 02 is only for transfers to a different acute care hospital. Internal moves are not reported in Field 17 unless the patient moves to a "PPS-Exempt" unit, such as an Inpatient Rehab (Code 62) or Psych unit (Code 65).
• Planned Readmission Codes (81-95): These codes are specific to the Hospital Readmissions Reduction Program. Using a "Planned Readmission" code without supporting documentation in the medical record will trigger a manual medical necessity review.

Related Codes & Fields

• Field 04: Type of Bill
• Field 06: Statement Covers Period
• Field 12: Admission Date
• Code 01: Discharged to home or self-care
• Code 02: Discharged/transferred to a short-term general hospital
• Code 03: Discharged/transferred to a skilled nursing facility (SNF)
• Code 06: Discharged to home under care of home health
• Code 20: Expired
• Code 30: Still a patient
• Code 62: Discharged/transferred to an IRF
• Code 63: Discharged/transferred to a LTCH

References

1. CMS Pub. 100-04 Chapter 3
2. Medicare Claims Processing Manual
3. CMS Post-Acute Care Transfer Policy