TMPPM 2010 > Volume 1, General Information > Section 6: Claims Filing > UB-04 CMS-1450 Claim Filing Instructions > Filing Tips for Outpatient Claims

   
 

6.6.6 Patient Status Codes

Code
Description

01

Routine Discharge

02

Discharged to another short-term general hospital

03

Discharged to SNF

04

Discharged to ICF

05

Discharged to another type of institution

06

Discharged to care of home health service organization

07

Left against medical advice

08

Discharged/transferred to home under care of a Home IV provider

09

Admitted as an inpatient to this hospital (only for use on Medicare outpatient hospital claims)

20

Expired or did not recover

30

Still patient (To be used only when the client has been in the facility for 30 consecutive days if payment is based on DRG)

40

Expired at home (hospice use only)

41

Expired in a medical facility (hospice use only)

42

Expired-place unknown (hospice use only)

43

Discharged/Transferred to a federal hospital (such as a Veteran's Administration [VA] hospital)

50

Hospice-Home

51

Hospice-Medical Facility

61

Discharged/ Transferred within this institution to a hospital-based Medicare-approved swing bed

62

Discharged/ Transferred to an Inpatient rehabilitation facility (IRF), including rehabilitation distinct part units of a hospital

63

Discharged/ Transferred to a Medicare certified long-term care hospital (LTCH)

64

Discharged/ Transferred to a nursing facility certified under Medicaid but not certified under Medicare

65

Discharged/ Transferred to a Psychiatric hospital or psychiatric distinct part unit of a hospital

66

Discharged/transferred to a critical access hospital (CAH)

6.6.7 Filing Tips for Outpatient Claims

The following are outpatient claim filing tips:

Use HCPCS codes in Block 44 when available and give a narrative description in Block 43 for all services and supplies provided.

Important: Services and supplies that exceed the 28 items per claim limitation must be submitted on an additional UB-04 CMS-1450 claim form and will be assigned a different claim number by TMHP. Claims may have 61 detail lines for services and supplies plus one detail line for the total amount billed.

Combine central supplies and bill as one item. IV supplies may be combined and billed as one item. Include appropriate quantities and total charges for each combined procedure code used. Using combination procedure codes conserves space on the claim form.

The 28-item limitation per claim: a UB-04 CMS-1450 claim form submitted with 28 or fewer items is given an internal control number (ICN) by TMHP. Multipage claim forms are processed as one claim for that client if all pages contain 28 or fewer items.

Itemized Statements: Itemized statements are not used for assignment of procedure codes. HCPCS codes or narrative descriptions of procedures must be reflected on the face of the UB-04 CMS-1450 claim form. Attachments will only be used for clarification purposes.

PT/OT procedures are based on time (initial 30 minutes or additional 15 minutes). Use the quantity billed to reflect the number of additional 15-minute increments.

Line Item
Description
Quantity

Example: one hour of PT service should be billed as two line items.

#1

Therapeutic exercise

1

#2

Additional 15 minutes

2

Refer to: Subsection 6.3.3, "Procedure Coding" in this section.


Texas Medicaid & Healthcare Partnership
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