UB04 Patient Discharge Status Code 61: Discharged/transferred to a hospital-based integrated skilled nursing facility (SNF)

Overview

Patient Discharge Status Code 61 is a UB‑04 field code defined by the Centers for Medicare & Medicaid Services (CMS) and published by Medicare administrative contractors such as Noridian. According to Noridian’s official list of patient discharge status codes, code 61 means “Discharged/transferred to a hospital-based Medicare approved swing bed.” ^[1] (see code 61 in the list). Although some providers colloquially refer to hospital‑based integrated skilled nursing facilities (SNFs), the official definition for code 61 is specifically a hospital‑based Medicare approved swing bed – a bed in a hospital that can be used for either acute or skilled nursing care, and the hospital has been certified by Medicare to provide swing‑bed services. Code 61 should not be used for a free‑standing SNF; that would be code 03. Noridian’s list also includes a related code 89 which adds a planned acute care hospital inpatient readmission to the same discharge type. ^[1] The MassHealth UB‑04 Billing Guide does not independently define discharge status codes but directs providers to use standard code sets. ^[2] (see “Code Sets for the UB-04 Claim Form,” page 23). Accurate use of code 61 is essential for correct reimbursement and to avoid claim denials or audit flags.

When to Use

Use code 61 when the patient is discharged from an acute care hospital and is transferred directly to a hospital‑based Medicare approved swing bed within the same or a different hospital. ^[1] The swing bed must be located in a hospital that has a Medicare swing‑bed approval. Common scenarios include:

• A patient who no longer requires acute inpatient care but still needs skilled nursing or rehabilitation services that can be provided in a hospital swing‑bed unit.
• A transfer from the hospital’s acute floor to the hospital’s own swing‑bed unit (internal transfer is still reported as a discharge from acute care with status code 61).
• A transfer to another hospital that has a swing‑bed program, provided the receiving facility is a hospital (not a free‑standing SNF).

Code 61 is not appropriate for:

• Transfer to a free‑standing Skilled Nursing Facility (use code 03).
• Transfer to an inpatient rehabilitation facility (use code 62).
• Transfer to a Long Term Care Hospital (use code 63).

Always verify that the receiving facility meets the Medicare definition of a hospital‑based swing bed before using code 61.

Step-by-Step Claim Example

Scenario: A 78‑year‑old patient was admitted to General Hospital for hip replacement surgery. After a 3‑day acute stay, the patient is stable enough to be transferred to the hospital’s own swing‑bed unit for 10 days of skilled nursing and rehabilitation. The hospital’s swing‑bed is Medicare certified.

Step 1 – Identify the correct discharge status. Because the patient is being moved to a hospital‑based Medicare approved swing bed within the same hospital, the discharge status is code 61. ^[1]

Step 4 – Verify billing guidelines. For paper claims, the UB‑04 must be completed per the guide.

Step 5 – Submit claim. The acute stay claim will reflect code 61 as the discharge status. The swing‑bed stay (if billed separately) will use admission source code 3 or other appropriate code. Ensure that the date of discharge from acute care and the date of admission to the swing bed are consistent.

Result: The claim is correctly coded, reducing risk of denial or audit scrutiny.

Common Mistakes & Audit Red Flags

1. Using code 61 for a free‑standing SNF. This is the most common error. Code 61 applies only to hospital‑based swing beds; free‑standing SNF transfers require code 03. Auditors will flag this mismatch. ^[1]

2. Mixing up code 61 with code 62 (IRF). A swing bed is not an inpatient rehabilitation facility. IRFs have distinct regulatory requirements and intensive therapy. Using the wrong code may lead to payment errors and medical review.

3. Using code 61 when the patient is discharged to a swing bed in another state or region. The receiving hospital must have Medicare swing‑bed approval. Verify the provider’s certification before selecting the code.

4. Incorrect discharge date/time. The discharge date/time from acute care must be properly entered in FL 12. If the transfer occurs at midnight, use 00:00 or as appropriate. Inconsistent time stamps between acute and swing‑bed records trigger audits.

5. Failure to include required value codes. For Medicare patients, value code 01 (Medicare Part A) and related amounts must be present. Missing value codes can delay payment. ^[2] (see “Value Codes” section).

Related Codes/Fields

The table below lists codes often confused with or adjacent to code 61 in Form Locator 17.

Code	Meaning (per Noridian)	When to Use Instead of Code 61
03	Discharged/transferred to skilled nursing facility (SNF) with Medicare certification	Free‑standing SNF (not hospital‑based swing bed)
62	Discharged/transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital	Intensive rehabilitation program, not swing‑bed
63	Discharged/transferred to a Medicare certified long term care hospital (LTCH)	Acute long‑term care hospital, not swing‑bed
64	Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare	Medicaid‑only nursing facility
80 (note: not in Noridian list but sometimes used)	Discharged/transferred to a hospital-based integrated SNF (not an official CMS code)	Do not use; code 61 is the correct CMS code for swing‑bed
89	Discharged/transferred to a hospital-based Medicare approved swing bed with a planned acute care hospital inpatient readmission	When the swing‑bed transfer is part of a planned readmission
01	Discharged to home or self‑care	Patient goes home
06	Discharged/transferred to home under care of organized home health service organization	Home health, not swing‑bed

All codes are from Noridian Patient Status list. ^[1] Providers should also verify correct use of Form Locator 15 (Source of Admission) and Form Locator 16 (Discharge Disposition) when applicable. The MassHealth UB‑04 Guide provides additional instructions for state‑specific requirements. ^[2] (see “How to Complete the UB-04 Claim Form”).

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References

[1] Noridian Patient Status — https://med.noridianmedicare.com/web/jea/topics/claim-submission/patient-discharge-status-codes

[2] MassHealth UB-04 Guide — https://www.mass.gov/doc/ub-04-billing-guide-0/download