UB04 Patient Discharge Status Code 91: Discharged/transferred to a Medicare certified long term care hospital (LTCH) with a planned acute care hospital readmission

Overview

Patient discharge status code 91 designates: “Discharged/transferred to a Medicare certified long term care hospital (LTCH) with a planned acute care hospital inpatient readmission.” This code became effective October 1, 2013, as part of the expanded set of “planned readmission” status codes (81–94) introduced by the National Uniform Billing Committee (NUBC) ^[1].
Code 91 is one of several statuses that explicitly indicate a planned acute care hospital readmission at the time of initial discharge. It applies specifically when the patient is moved to a Medicare‑certified LTCH, and the admitting hospital intends for the patient to return to an acute care hospital for a pre‑arranged inpatient stay. This distinction is important because the readmission is not an emergency or unplanned event; it is a scheduled part of the patient’s overall treatment plan.
While the guide does not list individual discharge status codes, it confirms that the UB‑04 is the standard form for billing acute inpatient services.

When to Use

Use code 91 when all three of the following conditions are met:

1. The patient is discharged from an acute care hospital and transferred directly to a Medicare‑certified long term care hospital (LTCH). The LTCH must have a valid Medicare certification number; freestanding LTCHs or distinct part units of a hospital qualify as long as they meet Medicare certification requirements.
2. At the time of discharge, the acute care hospital has a planned acute care hospital inpatient readmission already scheduled or documented in the medical record. This readmission must be for a continuation of care, a staged procedure, or another medically necessary inpatient service that was pre‑arranged.
3. The transfer is not to a nursing facility, rehabilitation facility, or any other setting; the destination must be a Medicare‑certified LTCH.

Use code 63 when the transfer to an LTCH is not accompanied by a pre‑planned acute care readmission. Use code 91 when a specific acute care inpatient stay is already scheduled to occur after the LTCH episode ^[1].

Step-by-Step Claim Example

Scenario: A 72‑year‑old patient with chronic obstructive pulmonary disease and respiratory failure is admitted to General Hospital. After initial stabilization, the patient is transferred to a Medicare‑certified long term care hospital (LTCH) for weaning from mechanical ventilation. The LTCH is expected to provide care for 2–3 weeks, after which the patient will return to General Hospital for a planned bronchoscopy and possible lobectomy. The readmission is pre‑scheduled and documented in the medical record.

Step 1 – Identify destination facility: Verify that the LTCH is Medicare‑certified by checking the CMS Provider of Services file. If the facility is not certified, use code 04 or 69, not code 91.

Step 2 – Document the planned readmission: The acute care hospital’s case manager obtains a signed order for the re‑admission and includes a planned readmission date in the patient’s discharge plan. This documentation must be present in the medical record before assigning code 91.

Step 3 – Complete UB‑04 Form Field 17 (Patient Discharge Status): Enter 91.

Step 4 – Submit claim: The claim is sent electronically (or on paper if a waiver is obtained) with all other required fields (e.g., revenue codes, dates of service, diagnosis codes). The claim will be processed with status code 91, indicating the patient was transferred to a Medicare‑certified LTCH with a planned acute care readmission ^[1].

Step 5 – Verify payment: The payer may request medical records to confirm medical necessity for both the LTCH transfer and the planned readmission. Ensure that the discharge summary and transfer paperwork are retained for audit.

Common Mistakes & Audit Red Flags

• Using code 91 when the LTCH is not Medicare-certified: Code 91 explicitly requires the LTCH to be Medicare‑certified. If the facility is not certified, use code 04 (custodial/supportive care) or code 69 (alternative care site). Using code 91 incorrectly may result in claim denial and an audit flag for improper discharge status reporting ^[1].

• Confusing code 91 with code 63: Code 63 is for LTCH transfers without a planned acute care readmission. Code 91 includes the planned readmission element. If the readmission is not documented at discharge, use code 63. Auditors will check the medical record for a written order or signed plan for the readmission.

• Using code 91 for unplanned readmissions: Code 91 is reserved for planned readmissions that are scheduled before the patient leaves the acute care facility. If the readmission later occurs due to an emergency or a new condition, the original discharge status should have been code 63 or another appropriate code. Retroactively changing the status to 91 is not allowed.

• Missing effective date compliance: Code 91 became effective October 1, 2013. Claims with a discharge date before that date must not use code 91. Using it on a pre‑2013 claim will trigger a rejection and potentially a billing compliance review.

• Failure to document the planned readmission: The medical record must contain clear documentation of the planned acute care inpatient readmission – including the reason, expected date, and the receiving physician’s concurrence. Without documentation, the claim is vulnerable to recoupment if audited.

Related Codes/Fields

The following patient discharge status codes are related to code 91; they all include the “with a planned acute care hospital inpatient readmission” modifier and became effective October 1, 2013. These are listed in the NUBC code set ^[1].

Code	Meaning
81	Discharged to home or self-care with a planned acute care hospital inpatient readmission
82	Discharged/transferred to a short-term general hospital for inpatient care with a planned acute care hospital inpatient readmission
83	Discharged/transferred to a SNF (Medicare certified) with a planned acute care hospital inpatient readmission
84	Discharged/transferred to a custodial/supportive care facility with a planned acute care hospital inpatient readmission
85	Discharged/transferred to a designated cancer center or children’s hospital with a planned acute care hospital inpatient readmission
86	Discharged/transferred to home under home health service with a planned acute care hospital inpatient readmission
87	Discharged/transferred to court/law enforcement with a planned acute care hospital inpatient readmission
88	Discharged/transferred to a federal health care facility with a planned acute care hospital inpatient readmission
89	Discharged/transferred to a hospital-based Medicare approved swing bed with a planned acute care hospital inpatient readmission
90	Discharged/transferred to an inpatient rehabilitation facility (IRF) with a planned acute care hospital inpatient readmission
91	Discharged/transferred to a Medicare certified long term care hospital (LTCH) with a planned acute care hospital inpatient readmission
92	Discharged/transferred to a nursing facility certified under Medicaid but not Medicare with a planned acute care hospital inpatient readmission
93	Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit with a planned acute care hospital inpatient readmission
94	Discharged/transferred to a critical access hospital (CAH) with a planned acute care hospital inpatient readmission

Additionally, code 63 (“Discharged/transferred to a Medicare certified long term care hospital”) is the base code without the planned readmission modifier. For any LTCH transfer that does not have a pre‑arranged acute care readmission, use code 63 instead of code 91. The pair (63 and 91) mirrors the pattern of other base/planned‑readmission code pairs (e.g., 01/81, 02/82) ^[1].

Field 17 on the UB‑04 claim form is the sole location for these patient discharge status codes. No other field on the UB‑04 directly interacts with code 91 except for the facility identification and billing provider fields that confirm the destination LTCH’s Medicare certification. Always ensure that the LTCH Medicare number is correctly reported in the claim to support the use of code 91.

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References

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