UB04 Patient Discharge Status Code 03: Discharged/transferred to a skilled nursing facility (SNF) with Medicare certification

Overview

Patient Status Code 03 is a specific discharge status used on the UB-04 claim form to indicate that a patient has been discharged or transferred to a skilled nursing facility (SNF) that possesses Medicare certification ^[1]. This code is part of the standardized "Patient Status" code set required for institutional billing by various healthcare facilities, including acute inpatient hospitals and acute outpatient hospitals ^[2]. The use of Code 03 signifies a transition in the level of care from an acute setting to a specialized facility equipped to provide skilled nursing or rehabilitation services under Medicare standards [PATIENT STATUS CODES].

The designation of Medicare certification is the primary differentiator for this code [PATIENT STATUS CODES]. While other codes exist for nursing facilities or custodial care, Code 03 is strictly reserved for those facilities that meet the specific regulatory requirements to be recognized as a Medicare-certified SNF [PATIENT STATUS CODES]. Proper application of this code is essential for accurate claim processing, as it informs the payer of the patient's post-discharge destination and may influence reimbursement calculations or the coordination of benefits between different levels of care ^[2].

When to Use

Code 03 should be utilized when the medical record confirms the patient is being transferred to a skilled nursing facility that is certified by Medicare [PATIENT STATUS CODES]. This code is appropriate for standard discharges where the patient is expected to receive skilled care at the receiving facility without an immediate plan for readmission to the originating hospital [PATIENT STATUS CODES]. It is distinct from Code 04, which is used for facilities providing only custodial or supportive care, and Code 64, which is used for nursing facilities certified only under Medicaid [PATIENT STATUS CODES].

Furthermore, Code 03 must be distinguished from codes involving "planned readmissions" [PATIENT STATUS CODES]. If a patient is discharged to a Medicare-certified SNF but has a scheduled acute care hospital inpatient readmission, Code 83 should be used instead of Code 03 [PATIENT STATUS CODES]. Additionally, Code 03 should not be used if the patient is moving to a hospital-based Medicare-approved "swing bed," as that scenario requires Code 61 [PATIENT STATUS CODES]. Providers must verify the certification status of the receiving facility to ensure the patient is indeed entering a Medicare-certified environment rather than a non-certified nursing home or a federal health care facility, the latter of which would require Code 43 [PATIENT STATUS CODES].

Step-by-Step Claim Example

To document a discharge to a Medicare-certified SNF on a paper UB-04 claim form, follow these steps:

1. Identify the Provider Type: Ensure the billing entity is among those required to use the UB-04 form, such as an acute inpatient hospital or a hospital-licensed health center ^[2].
2. Locate Field 17: Navigate to Form Locator 17 (Patient Status) on the UB-04 claim form ^[2].
3. Verify Facility Certification: Confirm through the discharge planning documentation that the destination facility is a skilled nursing facility (SNF) with active Medicare certification [PATIENT STATUS CODES].
4. Enter the Code: Enter the two-digit code "03" into the designated field [PATIENT STATUS CODES].
5. Check for Planned Readmission: Review the patient's care plan. If there is a planned acute care hospital inpatient readmission, remove "03" and enter "83" instead [PATIENT STATUS CODES].
6. Review Related Fields: Ensure the discharge date and other clinical data align with a transfer to a skilled nursing level of care ^[2].

Common Mistakes & Audit Red Flags

A frequent error in using Code 03 is the failure to distinguish between Medicare certification and Medicaid certification [PATIENT STATUS CODES]. Using Code 03 for a facility that is only Medicaid-certified is incorrect; in such instances, Code 64 is the appropriate selection [PATIENT STATUS CODES]. Audits often flag claims where Code 03 is used for patients transferred to custodial care facilities (which should be Code 04) or federal health care facilities (which should be Code 43), as these destinations do not meet the Medicare SNF criteria [PATIENT STATUS CODES].

Another significant red flag is the misuse of Code 03 when a planned readmission is documented in the medical record [PATIENT STATUS CODES]. Since the implementation of specific codes for planned readmissions on October 1, 2013, failure to use Code 83 (SNF with planned readmission) when applicable can lead to claim denials or audits for inaccurate reporting of patient status [PATIENT STATUS CODES]. Additionally, providers must avoid using Code 03 for transfers to "swing beds" within a hospital, as Code 61 is specifically designated for Medicare-approved swing bed transfers [PATIENT STATUS CODES]. Discrepancies between the discharge status code and the actual level of care provided at the receiving facility often trigger automated system flags during the adjudication process ^[2].

Related Codes/Fields

Code	Meaning
04	Discharged/transferred to a facility that provides custodial or supportive care [PATIENT STATUS CODES]
61	Discharged/transferred to a hospital-based Medicare approved swing bed [PATIENT STATUS CODES]
64	Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare [PATIENT STATUS CODES]
83	Discharged/transferred to a skilled nursing facility (SNF) with Medicare certification with a planned acute care hospital inpatient readmission [PATIENT STATUS CODES]
41	Expired in a medical facility (e.g., hospital, SNF, ICF, or free-standing hospice) [PATIENT STATUS CODES]
FL 17	Form Locator 17: The specific field on the UB-04 used to report Patient Status [2]

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References

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

[2] BILLING RULES — https://www.mass.gov/doc/ub-04-billing-guide-0/download