UB04 Patient Discharge Status Code 62: Discharged/transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital

UB04 Patient Discharge Status Code 62: Discharged/transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital

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Overview

Patient discharge status code 62 is used on the UB‑04 claim form to indicate that a patient was discharged or transferred from a hospital to an inpatient rehabilitation facility (IRF). The definition explicitly includes rehabilitation distinct part units of a hospital ^[1]. This code is recorded on the UB‑04 claim form.mass.gov/doc/ub-04-billing-guide-0/download). Code 62 distinguishes a transfer to a Medicare‑certified IRF from other types of post‑acute destinations, such as skilled nursing facilities (code 03) or long‑term care hospitals (code 63) ^[1]. Proper use of this code ensures accurate tracking of patient outcomes and appropriate reimbursement for the transferring facility.

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When to Use

Code 62 should be used when a patient leaves the hospital and is admitted directly to an inpatient rehabilitation facility (IRF). An IRF is a distinct Medicare‑certified hospital or a rehabilitation distinct part unit of a hospital that provides intensive, multidisciplinary rehabilitation services ^[1]. Typically, the patient requires a higher level of rehabilitative care than can be provided in a skilled nursing facility or at home. The transfer must be to a facility that meets Medicare’s IRF criteria, including a minimum of 60% of patients requiring treatment for one of 13 qualifying conditions. Code 62 is not appropriate for discharges to a swing bed (code 61), a Long‑Term Care Hospital (code 63), or a nursing facility certified only under Medicaid (code 64) ^[1]. If the patient is discharged home or to another setting, a different code must be selected. The code applies equally whether the IRF is a freestanding facility or a distinct part unit within an acute care hospital. Accurate use of code 62 is essential for Medicare billing and data reporting.

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Step-by-Step Claim Example

Scenario: A 72‑year‑old patient is admitted to an acute care hospital with a hip fracture. After surgery and four days of acute medical management, the patient no longer requires acute care but needs intensive physical therapy and occupational therapy. The attending physician determines that the patient meets criteria for an inpatient rehabilitation facility (IRF). The patient is transferred directly from the acute care hospital to a local Medicare‑certified IRF that is a separate hospital entity.

Claim Completion:

• Field 17 (Patient Discharge Status): Enter “62”.
• Field 12 (Discharge Hour): Enter the hour of transfer (e.g., “15” for 3:00 PM).
• Other fields: Provide appropriate dates (field 13 – admit date; field 16 – discharge date), patient demographics, and billing codes.

Explanation: The code 62 accurately reflects that the patient was discharged to an inpatient rehabilitation facility and not to a skilled nursing facility or home. The claim is submitted to Medicare as the primary payer. The transferring hospital documents the transfer in the medical record, including the name and Medicare identification number of the receiving IRF. Using code 62 ensures that the transfer is recorded correctly for utilization review and payment purposes. This example aligns with the definition provided in the Noridian patient status list: “Discharged/transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital” ^[1].

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Common Mistakes & Audit Red Flags

1. Using code 62 for a swing bed (code 61): Swing beds are hospital‑based Medicare approved swing beds, not IRFs. Using the wrong code can trigger an audit because the level of care and reimbursement differ ^[1].

2. Using code 62 for a Long‑Term Care Hospital (LTCH): Code 63 is designated for LTCH transfers. Mixing these codes may lead to claim denials or payment recoupment.

3. Failure to use code 90 when a planned acute care hospital inpatient readmission exists: If the patient is transferred to an IRF but a readmission to the same acute care hospital is planned within a specific timeframe, code 90 (discharged/transferred to an IRF with a planned acute care hospital inpatient readmission) must be used instead of code 62 ^[1].

4. Missing documentation of IRF eligibility: The medical record should clearly establish that the patient requires intensive rehabilitation and that the receiving facility meets IRF criteria. Auditors may request transfer documentation.

5. Incorrect transfer to a non‑Medicare‑certified facility: Code 62 should only be used for Medicare‑certified IRFs or rehabilitation distinct part units. Transfer to a facility that only provides custodial or supportive care would require code 04.

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Related Codes/Fields

The table below lists related patient discharge status codes used in field 17 of the UB‑04 claim form, including code 62 and other common transfer destinations. All codes are from the Noridian patient status list ^[1].

Code	Meaning	Source
61	Discharged/transferred to a hospital‑based Medicare approved swing bed	[1]
62	Discharged/transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital	[1]
63	Discharged/transferred to a Medicare certified long term care hospital (LTCH)	[1]
64	Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare	[1]
65	Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital	[1]
66	Discharged/transferred to a critical access hospital (CAH)	[1]
69	Discharged/transferred to a designated disaster alternate care site	[1]
70	Discharged/transferred to another type of health care institution not defined elsewhere	[1]
90	Discharged/transferred to an IRF including rehabilitation distinct part units with a planned acute care hospital inpatient readmission	[1]

Note: Code 90 is effective for claims with discharge dates on or after October 1, 2013, and must be used when a planned readmission to the same acute care hospital is anticipated within the same inpatient stay or a very brief interval ^[1].

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References

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