UB04 Patient Discharge Status Code 65: Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital

Overview

Patient Discharge Status Code 65 means “Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital.” ^[1] As defined by Noridian Medicare, this code is one of many standard discharge status codes used on the UB‑04 claim form. It specifically indicates that the patient left the current healthcare facility for a psychiatric hospital or a distinct part unit of a hospital that is devoted to psychiatric care. Accurate use of code 65 ensures proper reimbursement, correct patient care tracking, and compliance with billing regulations. It is distinct from code 93, which also addresses transfer to a psychiatric facility but includes a planned acute care hospital inpatient readmission.

When to Use

Code 65 should be used when a patient is discharged or transferred from a current inpatient setting (such as a general acute care hospital) directly to either a freestanding psychiatric hospital or a psychiatric distinct part unit (DPU) of another hospital. ^[1] Use code 65 only when no planned acute care hospital inpatient readmission is anticipated at the time of discharge. If a readmission is planned (e.g., the patient is expected to return for a scheduled procedure within a specified timeframe), then code 93 (with the same destination description) must be used instead. ^[1] The effective date for the planned readmission variant (code 93) is October 1, 2013. Always verify the destination facility’s type and the presence of a planned readmission before selecting this code.

Step‑by‑Step Claim Example

Scenario: A 45‑year‑old patient is admitted to a general acute care hospital for a medical condition. During the stay, the patient requires psychiatric stabilization and is determined to need inpatient psychiatric care. The patient is transferred to a freestanding psychiatric hospital three days later.

Step 1 – Identify the destination: The receiving facility is a licensed psychiatric hospital. According to Noridian, this qualifies as either a “psychiatric hospital” or a “psychiatric distinct part unit” – here it is the former. ^[1]

Step 2 – Check for a planned readmission: The transfer is not part of a planned acute care readmission; the patient is simply continuing care at a psychiatric facility. Therefore, code 93 is not appropriate.

Step 3 – Select code 65: On the UB‑04 claim form (Field 17 – Patient Discharge Status), enter “65”. The corresponding description is “Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital.” ^[1]

Step 4 – Complete the remainder of the UB‑04: Ensure other fields (e.g., patient information, provider identifiers, dates of service) are accurately populated per the payer’s requirements. MassHealth notes that acute inpatient hospitals must use the UB‑04 for paper claims. ^[2]

Step 5 – Submit the claim: The claim is submitted to the fiscal intermediary or payer. Code 65 tells the payer that the patient’s post‑discharge location is a psychiatric hospital, triggering appropriate payment and quality metrics.

Common Mistakes & Audit Red Flags

• Using code 65 when a planned readmission exists: Noridian explicitly lists two codes with identical destinations – code 65 (no planned readmission) and code 93 (with planned readmission). ^[1] Selecting code 65 instead of 93 for a patient who is expected to return for a planned acute care admission within a few days may result in claim denial or later adjustment. Auditors often cross‑match discharge status with subsequent readmission claims.

• Confusing “psychiatric distinct part unit” with a general hospital’s psychiatric unit that is not a distinct part: If the receiving unit is not certified as a distinct part (e.g., a consultation‑liaison service without separate inpatient beds), code 65 might not apply. Always verify the receiver’s Medicare provider agreement. The Noridian definition requires the unit to be a “psychiatric distinct part unit.” ^[1]

• Using code 65 for transfers to non‑psychiatric facilities: A patient sent to a skilled nursing facility with mental health services should not be coded as 65. The Noridian list includes separate codes for skilled nursing (03), nursing facility (64), and other destinations. Misuse can lead to audits and recoupments.

• Failure to update the code when the patient is discharged to a psychiatric hospital but is also being treated at the same time for an acute medical condition: Code 65 is appropriate even if the patient requires ongoing medical care, as long as the receiving facility is a psychiatric hospital.

• Incorrect placement of the code: On the UB‑04, discharge status code 65 is entered in Form Locator 17. Missing or wrong entries can cause the entire claim to be rejected. While the MassHealth guide does not provide field‑specific instructions in the excerpt, it emphasizes correct completion of the entire claim form. ^[2]

Related Codes/Fields

Code	Meaning (from Noridian)	Notes
65	Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital	Use when no planned acute care readmission
93	Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital with a planned acute care hospital inpatient readmission	Effective 10/1/13; use for transfers where readmission is planned
62	Discharged/transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct part units	Similar distinct‑part concept but for rehabilitation
63	Discharged/transferred to a Medicare certified long term care hospital (LTCH)	Another specialty hospital destination
69	Discharged/transferred to a designated disaster alternate care site	Effective 10/1/13; for emergency preparedness transfers

All codes are from the Noridian patient discharge status code list. ^[1] The UB‑04 field for discharge status is Field 17. Correct selection among these related codes is critical to avoid claim processing errors.

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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