Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). CPT 91311, 0111A, 0112A Covid Vaccine for children, 5 Important points to improve claim submission success rate. 0000006647 00000 n
Please be sure to reference SE0801 and SE1411 for more details. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. 0000003442 00000 n
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The AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. Web0 = Unknown Value (but present in data) 01 = Discharged to home/self-care (routine charge). It can be used for both inpatient or outpatient claims. AMA Disclaimer of Warranties and Liabilities CDT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. WebMLN Matters article SE0801 is provided to assist providers in determining the right discharge status code to use with their claims. 2730 0 obj
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Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. Patient has WC and Medicare insurance? 30 Still Patient or Expected to Return for Outpatient Services The .gov means its official. %PDF-1.6
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You, your employees and agents are authorized to use CPT only as contained in the following authorized materials: Local Coverage Determinations (LCDs), training material, publications, and Medicare guidelines, internally within your organization within the United States for the sole use by yourself, employees and agents. hbbd``b`f " BD
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Correction to Patient Discharge Status Codes in Medicaid Providers Manual Information posted February 1, 2013. New Definition for Patient Discharge Status Code 05 Effective, per National Uniform Billing Committee (NUBC), on April 1, 2008: 05 Discharged/Transferred to a Designated Cancer Center or Childrens Hospital Usage Note: Transfers to non-designated cancer hospitals should use Code 02. 0000048264 00000 n
This warning banner provides privacy and security notices consistent with applicable federal laws, directives, and other federal guidance for accessing this Government system, which includes all devices/storage media attached to this system. You can decide how often to receive updates. 08. The following patient discharge status codes should only be used when submitting hospice claims: All Rights Reserved (or such other date of publication of CPT). Font Size:
You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. xref
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The revenue codes and UB-04 codes are the IP of the American Hospital Association. 0
Discharge status code list. 0000048794 00000 n
Answer: Episodes for patients discharged to a non-institutional (home) hospice (M0100 Reason for assessment RFA 9 Discharge from Agency) where M2420 Discharge Disposition is coded with Response 3 Patient transferred to a non-institutional hospice, and with a M0906 Discharge/Transfer/Death Date of 1/1/2023 or Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT-4 for resale and/or license, transferring copies of CDT-4 to any party not bound by this agreement, creating any modified or derivative work of CDT-4, or making any commercial use of CDT-4. These patient discharge status codes are reserved for national assignment. No fee schedules, basic unit, relative values or related listings are included in CDT-4. These two patient discharge status codes are used to identify when a patient is discharged or transferred to hospice care. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. These codes are important in understanding the discharge status as reported to CMS by the hospital and may impact post-acute Medicare Part A coverage in the skilled nursing facility and home care. U.S. Department of Health & Human Services %PDF-1.4
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WebIPPS, but does not have an agreement to participate in the Medicare program (Patient Discharge Status Code 02 or 82 when an Acute Care Hospital Inpatient Readmission is 0000093210 00000 n
Webadjustment bill to correct the discharge status code following Medicares claim adjustment criteria located in the Medicare Claims Processing Manual, Chapter 1, Section 130.1.1 0000010568 00000 n
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For non-emergency services & during normal business hours, please submit a ticket online by clicking here: the hospital should submit an adjustment bill to correct the discharge status code following Medicares Bookmark |
The site is secure. License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. In cases in which two or more Patient Discharge Status codes apply, providers should code the highest level of care known. 0000109611 00000 n
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This is a correction to the Texas Medicaid Provider Procedures Manual (TMPPM), Volume 1, General Information, subsection 6.6.6, Patient Discharge Status Codes. The table in this subsection in the December 2012 and January 2013 editions of the TMPPM has the following errors: Code 03 should not be used if the patient is admitted to a non-Medicare certified area. 20 Expired Any questions pertaining to the license or use of the CDT should be addressed to the ADA. No fee schedules, basic unit, relative values or related listings are included in CPT. WebRefer an Agencyand get up to $2,500! 0000014662 00000 n
New Patient Discharge Status Code 21 to Define Discharges or Transfers to Court/Law Enforcement. Hospital Inpatient Claims (type of bills (TOBs) 11X and 12X); Skilled Nursing Claims (TOBs 18X, 21X, 22X and 23X); Outpatient Hospital Services (TOBs 13X, 14X, 71X, 73X, 74X, 75X, 76X and 85X); and. Designed by Elegant Themes | Powered by WordPress. CPT codes, descriptions and other data only are copyright 2002-2020 American Medical Association (AMA). DISCLAIMER: The contents of this database lack the force and effect of law, except as You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. An announcement was also made at the September 2017 ICD-10 Coordination and Maintenance Committee meeting that FY 2018 would be the last GEMs file update. Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline, Medicare revalidation process how often provide need to do FAQ, Step by step Guide Medicare participation program. 812 25
On-Call for Critical Requests: Holidays and Outside Business Hours call 989.583.6014. Washington, D.C. 20201 43 Discharged/Transferred to a Federal Hospital 66 Discharged/Transferred to a CAH ( Click here to review the rule in the Federal Register.) This code should not be used for home health services provided by a: M >g:V
The scope of this license is determined by the AMA, the copyright holder. Patients who leave before triage, or are triaged and leave without being seen by a physician; or Unless a patient has already been admitted to/accepted by a hospice, level of care cannot be determined. All the articles are getting from various resources. hb```f``= "@1v u0Yh0 Yx84K;jssz+];=G$J3x. Web04. xbbbf`b```%F8w4F|Qb4Ga ! The fourth digit is indicative of the submission frequency, and should align with the Patient Discharge Status reported on the claim. Web 482.43 Condition of participation: Discharge planning. Nor transfers to a CAH swing bed should still be coded with Patient discharge status Code 61. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816. a. In addition, CMS has added a specific code for discharges related to disaster situations. WebThe grouper software is updated by CMS at the beginning of each federal fiscal year (October 1st) and applied to patient records based on their reported discharge date. Based on national guidelines for completing and submitting a UB-04 (or the electronic comparative) a provider must assign a Patient Discharge Status code which aligns with the type of bill (TOB) submitted. The AMA is a third-party beneficiary to this license. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. Before sharing sensitive information, make sure youre on a federal government site. lock The patient is admitted from home (a private residence) to an acute setting. The patient has elected the hospice benefit and will be receiving hospice care under arrangement with a hospice organization; the patient is receiving residential care only; Whether the bed is Medicare certified or not. The level of care that will be provided by the hospice upon discharge is essential to determining the proper code to use. ). It is important to select the correct Patient Discharge Status code. endstream
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<. This code should be reported when a patient is: Constrained to codes in the Discharge Disposition: Discharge To Acute Care Facility value set (2.16.840.1.113883.3.117.1.7.1.87), QDM Attribute and Definition (QDM Version 5.5 Guidance Update). These patient discharge status codes are reserved for national assignment. FOURTH EDITION. For U.S. Government and other information systems, information accessed through the computer system is confidential and for authorized users only. The CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. Patient discharge status code 04 is typically defined at the state level for specifically designated Race/Ethnicity: In 2021, 30,161 White patients were discharged to hospice, more than for other Race/Ethnicity groups. `U~F+$4h means youve safely connected to the .gov website. Assigning the correct patient discharge 0000010530 00000 n
All Rights Reserved to AMA. Some of the descriptions of the discharged status codes were changed prematurely. Email |
You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. A discharge occurs when a Medicare beneficiary leaves an acute care hospital after receiving acute care treatment; or dies in the hospital. A patient discharge status code is a two-digit code that identifies where the patient is at the conclusion of a health care facility encounter or at the end of a billing cycle (the through' date of a claim). BY CLICKING ABOVE ON THE LINK LABELED "I Accept", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THESE AGREEMENTS. The NUBC has also clarified that this code should also be used when a patient is transferred to an inpatient psychiatric unit of a Veterans Administration hospital. 2. 04 Discharged/Transferred to an Intermediate Care Facility (ICF) 200 Independence Avenue, S.W. 09. or The .gov means its official. The level of care the patient is receiving; and CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT. This patient discharge status code is reserved for national assignment. Reproduced with permission. IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "I DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN. End Users do not act for or on behalf of the CMS. These 2023 ICD-10-CM codes are to be used for discharges occurring from October 1, 2022 through September 30, 2023 and for patient encounters occurring from October 1, 2022 through September 30, 2023. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements. The discharge disposition code 06 is for patients who are discharged or transferred to home under care of organized home health service organization. ( 07. 0
On outpatient claims, the primary method to identify that the patient is still receiving care is the bill type frequency code (e.g., Frequency Code 3: Interim Continuing Claim). A patient discharge status code is a two-digit code that identifies where the patient is at the conclusion of a health care facility encounter (this could be a visit or an actual inpatient stay) or at the time end of a billing cycle (the through date of a claim). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. 0000009067 00000 n
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Swing beds are not part of the post acute care transfer policy. Note: The information obtained from this Noridian website application is as current as possible. 02 Discharged/Transferred to a Short Term General Hospital for Inpatient Care The 2023 ICD-10-CM files below contain information on the ICD-10-CM updates for FY 2023. 03 Discharged/Transferred to a Skilled Nursing Facility (SNF) with Medicare Certification in Anticipation of Skilled Care. Applications are available at the AMA website. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. 61 Discharged/Transferred to a Hospital-based Medicare Approved Swing Bed 0000014285 00000 n
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U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements. Patient Discharge Status Codes and Their Appropriate Use 0000092313 00000 n
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To obtain comprehensive knowledge about the UB-04 codes, the Official UB-04 Data Specification Manual is available for purchase on the American Hospital Association Online Store. 62 Discharged/Transferred to an Inpatient Rehabilitation Facility Including Distinct Part Units of a Hospital 0000001136 00000 n
The use of the information system establishes user's consent to any and all monitoring and recording of their activities. Inpatient Respite Patient discharge status code 51: Hospice medical facility should be used if the patient went to a facility that is qualified and the patient is receiving hospice inpatient respite level of care. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. This code applies to discharges and transfers to a government operated health care facility including: Veterans Administration hospitals; or You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. 222 42
For a full list of available versions, see the Directory of published versions Using Codes Code Systems Value Sets Concept Maps Identifier Systems Discharged/transferred to a designated cancer center or children's hospital. 65 Discharged/Transferred to a Psychiatric Hospital or Psychiatric Distinct Part Unit of a Hospital This will prevent incorrect billing of the Discharge Status Code and avoid unnecessary adjustments to claims when the incorrect code is used. These patient discharge status codes are reserved for national assignment. Return to the Patient List view and click the minutes ago button to refresh your patient list 3. Last Updated: Jul 08, 2021 <<5887C3D76045B64BA1888B73E4DDD033>]>>
07 Left Against Medical Advice or Discontinued Care CMS DISCLAIMER. United HealthCare Community Plan requires Patient Discharge Status codes for: ** Hospital Inpatient Claims (TOBs 11X and 12X); AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING. End Users do not act for or on behalf of the CMS. How to TRANSITIONING/TRANSFERRING OF ENROLLEES to MCO, What is Patient driven Grouping model how its working, Workers Compensation Medicare Set-Aside Arrangement (WCMSA) Full coverage, Understanding Medicare cost Reports and usage. A patient discharge status code is a two-digit code that identifies where the patient is at the conclusion of a health care facility encounter (this could be a visit or an actual inpatient stay) or at the time end of a billing cycle (the through date of a claim). 0000003110 00000 n
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The recent CMS discharge planning rule that went into effect in November 2019 included several changes aimed at improving care transitions and encouraging patients involvement in their follow-up treatment and care protocols. 2750 0 obj
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Applications are available at the, Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. 0000002967 00000 n
** All Hospice and Home Health Claims (TOBs 32X, 33X, 34X, 81X and 82X). This sdtc:dischargeDispositionCode SHOULD contain exactly [0..1] code, which SHOULD be selected from ValueSet 2.16.840.1.113883.3.88.12.80.33 NUBC UB-04 FL17-Patient Status Some of the Provider information contained on the Noridian Medicare web site is copyrighted by the American Medical Association, the American Dental Association, and/or the American Hospital Association. Clinical Focus: This value set contains concepts that represent a patient leaving against medical advice. In this case, see Patient discharge status Code 43. End users do not act for or on behalf of the CMS. Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming, Last Updated Tue, 18 Jan 2022 20:55:43 +0000. ** The fourth digit indicates the sequence of the bill for a specific episode of care. A patient discharge status code is a two-digit code that identifies where the patient is at the conclusion of a health care facility encounter (this could be a visit or an actual inpatient stay) or at the time end of a billing cycle (the through' date of a claim). Discharged/transferred to a designated cancer center or children's hospital. The scope of this license is determined by the ADA, the copyright holder. (Note: your organization may need to subscribe.). Discharges or transfers to long-term care hospitals (LTCHs) should be coded with Patient discharge status Code 63. For hospitals with an approved swing bed arrangement, providers should use Code 61- Swing Bed. Applications are available at the AMA Web site, https://www.ama-assn.org. THE LICENSES GRANTED HEREIN ARE EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THESE AGREEMENTS. <]/Prev 800918>>
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This code indicates that the patient is discharged/transferred to a Medicare-certified nursing facility in anticipation of skilled care. 0000006885 00000 n
This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. This is the current published version. The AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. WebThe Grouper allows users to enter one or more ICD-10-CM diagnosis codes and any applicable ICD-10-PCS procedure codes along with some other required inputs, click a button, and quickly get the resulting DRG and other important information (including the Relative Weight, Length of Stay, Procedure Type, Post Acute indication, etc. Age: In 2021, about 54 percent of total discharges to hospice care were patients aged 70-89. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. According to the NUBC, discontinued services may include: Discharged/transferred to home under care of organized home health service organization in anticipation of covered skilled care. You acknowledge that the AMA holds all copyright, trademark, and other rights in CPT. Left against medical advice or discontinued care. WebKey Findings. Nursing facilities may elect to certify only a portion of their beds under Medicare, and some nursing facilities choose to certify all of their beds under Medicare. , November 23, 2016 - Revised March 18, 2021, Patient discharge status codes identify where a patient is at the conclusion of a health care facility encounter or at the end of a billing cycle. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. End users do not act for or on behalf of the CMS. 0000000016 00000 n
Therefore, you have no reasonable expectation of privacy. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. else{document.getElementById("usprov").href="/web/"+"jeb"+"/help/us-government-rights";}, Advance Beneficiary Notice of Noncoverage (ABN), Cardiac and Pulmonary Rehabilitation Programs, Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), Acute Inpatient Prospective Payment System (IPPS) Hospital, Comprehensive Outpatient Rehabilitation Facility (CORF), Fee-for-Time Compensation Arrangements and Reciprocal Billing, Outpatient Prospective Payment System (OPPS), Provider Appeal Requests - PRRB or Contractor Hearings, Provider Statistical and Reimbursement (PS&R) System, Documentation Requests: How, Who and When to Send, Medical Documentation Signature Requirements, Supplemental Medical Review Contractor (SMRC), Unified Program Integrity Contractor (UPIC), Provider Outreach and Education Advisory Group (POE AG), PECOS and the Identity and Access Management System, Provider Enrollment Reconsiderations, CAPs, and Rebuttals, click here to see all U.S. Government Rights Provisions, American Hospital Association Online Store, Discharged to home or self-care (routine discharge), Discharged/transferred to a short-term general hospital for inpatient care, Discharged/transferred to skilled nursing facility (SNF) with Medicare certification, Discharged/transferred to a facility that provides custodial or supportive care, Discharged/transferred to a designated cancer center or children's hospital, Discharged/transferred to home under care of organized home health service organization in anticipation of covered skilled care, Left against medical advice or discontinued care, Admitted as an inpatient to this hospital, Discharged/transferred to court/law enforcement, Expired in a medical facility (e.g., hospital, SNF, ICF, or free-standing hospice), Discharged/transferred to a federal health care facility, Hospice - medical facility (certified) providing hospice level of care, Discharged/transferred to a hospital-based Medicare approved swing bed, Discharged/transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital, Discharged/transferred to a Medicare certified long term care hospital (LTCH), Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare, Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital, Discharged/transferred to a critical access hospital (CAH), Discharged/transferred to a designated disaster alternate care site (effective 10/1/13), Discharged/transferred to another type of health care institution not defined elsewhere in this code list, Discharged to home or self-care with a planned acute care hospital inpatient readmission (effective 10/1/13), Discharged/transferred to a short-term general hospital for inpatient care with a planned acute care hospital inpatient readmission (effective 10/1/13), Discharged/transferred to a skilled nursing facility (SNF) with Medicare certification with a planned acute care hospital inpatient readmission (effective 10/1/13), Discharged/transferred to a facility that provides custodial or supportive care with a planned acute care hospital inpatient readmission (effective 10/1/13), Discharged/transferred to a designated cancer center or children's hospital with a planned acute care hospital inpatient readmission (effective 10/1/13), Discharged/transferred to home under care of organized home health service organization in anticipation of covered skilled care with a planned acute care hospital inpatient readmission (effective 10/1/13), Discharged/transferred to court/law enforcement with a planned acute care hospital inpatient readmission (effective 10/1/13), Discharged/transferred to a federal health care facility with a planned acute care hospital inpatient readmission (effective 10/1/13), Discharged/transferred to a hospital-based Medicare approved swing bed with a planned acute care hospital inpatient readmission (effective 10/1/13), Discharged/transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital with a planned acute care hospital inpatient readmission (effective 10/1/13), Discharged/transferred to a Medicare certified long term care hospital (LTCH) with a planned acute care hospital inpatient readmission (effective 10/1/13), Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare with a planned acute care hospital inpatient readmission (effective 10/1/13), 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), Discharged/transferred to a critical access hospital (CAH) with a planned acute care hospital inpatient readmission (effective 10/1/13), Discharged/transferred to another type of health care institution not defined elsewhere in this code list with a planned acute care hospital inpatient readmission (effective 10/1/13).