Looking for more information about Discharge Disposition in Readmissions? BESLER’s Vice President of Revenue Integrity, Mary Devine, answers your questions from the recent webinar.
To watch Mary’s Discharge Disposition in Readmissions Webinar, click HERE.
- Is there a list of DRGs that CMS considers readmission DRGs?
Readmissions is based on the primary diagnosis, not the DRG. Diagnosis codes of: Heart failure, pneumonia, COPD, MI, Total knee, Total hip, and CABG.
- Planned readmissions–does that only apply to a patient that is being admitted back to the discharging facility?
No, this would apply to any planned readmission.
- What is the time frame to correct the disposition code?
Whenever you realize the claim is coded incorrectly, it should be corrected. You have 4 years with a claim re-opening to correct it via DDE. If it is an underpayment, you will receive the additional reimbursement up to 4 years. If it is overpaid, you are required to report back 5 years for all over payments.
- Are the 7 DX codes listed in the presentation?
Yes, Heart failure, pneumonia, MI, COPD, Total Knee, Total Hip, and CABG.
- In the example given where the patient is discharged with pneumonia and then readmitted to another facility, if it is counted, can the facility expect a rejection on these in order to resubmit the claim with the correct discharge code in order not to be counted?
The discharge status code has no impact on whether the readmission is counted or not. If a patient is discharged with a primary diagnosis of pneumonia and is readmitted to any acute care facility within the the next 30 days, the readmission is counted.
- Readmission penalties are only based on the 7 primary diagnosis codes, correct?
Readmission penalty rate is based on those 7 diagnosis codes; the penalty is applied to all readmissions.
- Planned readmissions discharge dispositions . . .our business office has reported those dispositions aren’t allowed. Other information has suggested they are only used with certain DRGs (280-282). Do you have any further information on this?
Those discharge status codes are for all inpatient discharges. They were originally set to track MI readmission, but now should be utilized on all discharges where a planned readmission is known.
- What is the correct disposition code when a patient is signing out AMA, but home care is set up for the patient at the same time?
Medicare requires you to code the discharge status code to the highest you are aware. In this scenario, you would need to use an 06, Homecare, or your claim would reject.
- Is there any additional impact for patients (financial) who are readmitted on the same day?
There is not. It is important to note, if a discharge is impacted by the rule and paid a per diem, the patient is not charged the deductible.
- If a claim is returned indicating that discharge status should be 02 rather than 01, does the facility change DC status even though it does not match what is documented in the record?
You must change the discharge status to an 02 or the claim will reject and not pay.
- What would be the correct discharge disposition if the patient was intending to be seen by home health, but came back to the hospital before home health had a chance to see them?
If it was on the same day, it would need to be an 02. If it was the following day or after, it would be an 01, providing the home care was never started. If it started within 10 days, it would need to be an 06 cc 43, which indicates the home care started, just not within 3 days.
Related Resources
- Webinar: Discharge Disposition in Readmissions (recording and slides)
- Podcast: Discharge Disposition in Readmissions
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