CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. 0000047974 00000 n Keep Up To Date On New VBP Info - AAPC Knowledge Center 222 0 obj <> endobj Patient discharge status Code 51 should be used when a patient is: 0000002063 00000 n Unauthorized or illegal use of the computer system is prohibited and subject to criminal and civil penalties. 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 The primary method to identify that the patient is still receiving care is the bill type frequency code (e.g., Frequency Code 2: Interim First Claim, or Frequency Code 3: Interim Continuing Claim) Bill types ending in 2 or 3 should be reported with patient status of 30. This license will terminate upon notice to you if you violate the terms of this license. Still others elect not to certify any of their beds under Medicare. hmo0^P?]& V5hTED When a patient is discharged from an acute hospital to a Critical Access Hospital (CAH) swing bed, use patient discharge status code 61. You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. Web05. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. BY CLICKING BELOW ON THE BUTTON LABELED "I ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT. These patient discharge status codes are reserved for national assignment. 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. 0000008274 00000 n Improper payments This code is used for reporting patients discharged/transferred to a SNF level of care within the hospitals approved swing bed arrangement. CPT is a trademark of the AMA. Issued by: Centers for Medicare & Medicaid Services (CMS). WebCMS requires patient discharge status codes for: Hospital Inpatient Claims (type of bills (TOBs) 11X and 12X); Skilled Nursing Claims (TOBs 18X, 21X, 22X and 23X); Outpatient 40 Expired at Home This code is for use only on Medicare and TRICARE claims for hospice care; 0 1. All Hospice and Home Health Claims (TOBs 32X, 33X, 34X, 81X and 82X). Unless a patient has already been admitted to/accepted by a hospice, level of care cannot be determined. Inpatient rehabilitation facilities (or designated units) are those facilities that meet a specific requirement that 75% of their patients require intensive rehabilitative services for the treatment of certain medical conditions. 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. United HealthCare Community Plan requires Patient Discharge Status codes for: ** Hospital Inpatient Claims (TOBs 11X and 12X); 0000010568 00000 n Veterans Administration hospitals; or Sign In - Log in WebThis is the current published version in it's permanent home (it will always be available at this URL). 0 LICENSE FOR USE OF "PHYSICIANS' CURRENT PROCEDURAL TERMINOLOGY", (CPT) 518.867.8384 fax, Assisted Living and Adult Care Facilities. 05. DISCLAIMER: The contents of this database lack the force and effect of law, except as 0000006885 00000 n A federal government website managed by the The Centers for Medicare and Medicaid Services (CMS) issued two Medlearn Matters articles under the heading of Clarification of Patient Discharge Status Codes and Hospital Transfer Policies and numbered SE0801 and SE1411. Applying the correct code will help assure that the providers receive prompt and correct payment. 0000003474 00000 n Patient Discharge Status Codes and Their Appropriate Use CDT is a trademark of the ADA. For a full list of available versions, see the Directory of published versions Using Codes Code Systems Value Sets Concept Maps Identifier Systems %PDF-1.6 % 518.867.8383 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). 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). X XMCE 5764.2 FISS shall map patient discharge status code 70 to IPPS Pricer review code 00 (as is 0000093210 00000 n The table omitted patient status discharge codes that continue to be valid in the TMHP claims processing system: 5. The discharge status code identifies where the patient is being discharged to at the end of their facility stay or transferred to such as an acute/post-acute facility. The discharging facility should ensure that documentation in the patients medical record supports the billed discharge status code. ** The third digit classifies the type of care being billed. (Note: your organization may need to subscribe.). DISCLAIMER: The contents of this database lack the force and effect of law, except as Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare and Medicaid Services (CMS). ( New Patient Discharge Status Code 21 to Define Discharges or Transfers to Court/Law Enforcement. Share sensitive information only on official, secure websites. Before sharing sensitive information, make sure youre on a federal government site. A: Yes, it can be used on both types of claims. For hospitals with an approved swing bed arrangement, providers should use Code 61- Swing Bed. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. U.S. Department of Health & Human Services Any questions pertaining to the license or use of the CDT should be addressed to the ADA. Home This patient discharge status code is reserved for national assignment. Washington, D.C. 20201 20 Expired 62 Discharged/Transferred to an Inpatient Rehabilitation Facility Including Distinct Part Units of a Hospital Discharge Disposition 0000093113 00000 n Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827, 13 British American Blvd Suite 2 The scope of this license is determined by the ADA, the copyright holder. In cases in which two or more Patient Discharge Status codes apply, providers should code the highest level of care known. IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK ABOVE ON THE LINK LABELED "I Do Not Accept" AND EXIT FROM THIS COMPUTER SCREEN. Additional Guidance on Use of Patient discharge status Code 50 or 51. THE LICENSES GRANTED HEREIN ARE EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THESE AGREEMENTS. To sign up for updates or to access your subscriber preferences, please enter your contact information below. The AMA does not directly or indirectly practice medicine or dispense medical services. Please click here to see all U.S. Government Rights Provisions. These materials contain Current Dental Terminology, (CDT), copyright 2020 American Dental Association (ADA). Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. The intent of this data element is to identify the final place or setting to which the patient was discharged on the day of 0000004573 00000 n Discharge 52-60 Reserved for National Assignment LTCHs are facilities that provide acute inpatient care with an average length of stay of 25 days or greater. Cancer hospitals excluded from Medicare Prospective Payment System (PPS) and childrens hospitals are examples of such other types of health care institutions. LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT"). list of discharge disposition codes 2021 - Sensornor.com 0000014285 00000 n 0000007325 00000 n CMS Disclaimer 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 Note: This code should not be used when a patient is transferred to an inpatient psychiatric unit of a federal hospital (e.g., Veterans Administration Hospitals). The following patient discharge status codes should only be used when submitting hospice claims: 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. 03 = Discharged/transferred to skilled nursing facility (SNF) with Medicare certification in anticipation of covered skilled care (For hospitals with an approved swing Reporting incorrect patient discharge status codes may result in the following: CMS published the following Special Edition MLN Matters articles to provide clarifications and instructions on determining the correct patient discharge status code to use when completing your claims: For the purpose of discussing transfers the following terms describe when a patient leaves the hospital. This code is for use only on Medicare outpatient claims, and it applies only to those Medicare outpatient services that begin greater than three days prior to an admission. 63 Discharged/Transferred to Long Term Care Hospitals (LTCHs) 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. All Rights Reserved. 66 Discharged/Transferred to a CAH These two patient discharge status codes are used to identify when a patient is discharged or transferred to hospice care. Patient discharge status Code 50 should be used if the patient went to his/her own home or an alternative setting that is the patients home, such as a nursing facility, and will receive in-home hospice services. Reimbursement Guidelines from UHC insurance. Patient Discharge Status Code 30 should be used on inpatient claims when billing for leave of absence days, and for inpatient and outpatient interim bills. https:// This code applies to discharges and transfers to a government operated health care facility including: 0000006647 00000 n License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. According to the NUBC, discontinued services may include: All the articles are getting from various resources. The level of care that will be provided by the hospice upon discharge is essential to determining the proper code to use. 200 Independence Avenue, S.W. These patient discharge status codes are reserved for national assignment. CDT is a trademark of the ADA. Reserved for national assignment. WebThey are generally infections that occur more than 48 to 72 hours after _____ and within 10 days after hospital discharge. var pathArray = url.split( '/' ); Web0 = Unknown Value (but present in data) 01 = Discharged to home/self-care (routine charge). 65 Discharged/Transferred to a Psychiatric Hospital or Psychiatric Distinct Part Unit of a Hospital Review of Hospital Compliance with Medicare's The AMA is a third party beneficiary to this Agreement. Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen. You can decide how often to receive updates. authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically This code should be reported when a patient is: Before you can enter the Noridian Medicare site, please read and accept an agreement to abide by the copyright rules regarding the information you find within this site. discharge disposition codes 2021 0000006148 00000 n Patients who leave before triage, or are triaged and leave without being seen by a physician; or 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. The .gov means its official. Patient has WC and Medicare insurance? 50 and 51 Discharged/Transferred to a Hospice What is discharge status code 03? Patient Discharge Status Codes and Hospital Transfer Policies If you find anything not as per policy. 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. The ADA does not directly or indirectly practice medicine or dispense dental services. Rolling Stone Media Kit 2021; National Verifier Ebb Number; Tenerife Airport Disaster Bodies; Stellaris: Console Edition This article is based on Change Request (CR) 6385 which provides implementing instructions for a new patient discharge status code 21, which defines discharges WebConstrained 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 All rights reserved. Any communication or data transiting or stored on this system may be disclosed or used for any lawful Government purpose. Therefore, you have no reasonable expectation of privacy. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. 0000002026 00000 n website belongs to an official government organization in the United States. End Users do not act for or on behalf of the CMS. 30 Still Patient or Expected to Return for Outpatient Services CMS requires patient discharge status codes for: In addition, CMS emphasizes that proper discharge coding is just as critical a factor in ensuring proper claims filing and processing as any other coding and providers are responsible for ensuring accurate discharge designations. These patient discharge status codes are reserved for national assignment. 02 = Discharged/transferred to other short term general hospital for inpatient care. cms discharge disposition codes 2021 - Squaredomus.com For U.S. Government and other information systems, information accessed through the computer system is confidential and for authorized users only. 0000002491 00000 n You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. 2023 ICD-10-CM | CMS - Centers For Medicare & Medicaid Services ** The fourth digit indicates the sequence of the bill for a specific episode of care. 64 Discharged/Transferred to a Nursing Facility Certified Under Medicaid but not Certified Under Medicare 2742 0 obj <>/Filter/FlateDecode/ID[<53B0157D40280326833A3E6B2AA10E6C>]/Index[2730 21]/Info 2729 0 R/Length 67/Prev 112585/Root 2731 0 R/Size 2751/Type/XRef/W[1 2 1]>>stream o 71 Discharge to another institution of outpatient services Please be sure to reference SE0801 and SE1411 for more details. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (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. Webcms discharge disposition codes 2021 the dua made at tahajjud is like an arrow what is the purpose of the book of isaiah cms discharge disposition codes 2021 Home You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. 0000048794 00000 n 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 UnitedHealthCare Community Plan will deny claims when the Patient Discharge Status is inconsistent with the type of bill reported. The fourth digit is commonly referred to as the frequency code. Discharges or transfers to long-term care hospitals (LTCHs) should be coded with Patient discharge status Code 63. Discharged/transferred to a designated cancer center or children's hospital. These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright 2002, 2004 American Dental Association (ADA). MLN Matters article SE0801 is provided to assist providers in determining the right discharge status code to use with their claims. Bookmark | The Office of Inspector General (OIG) conducted several reviews identifying Medicare overpayments to hospitals that did not comply with the post-acute care transfer policy. Discharge Disposition": "Left Against Medical Advice %%EOF Race/Ethnicity: In 2021, 30,161 White patients were discharged to hospice, more than for other Race/Ethnicity groups. This code should be used regardless of whether or not the patient has skilled benefit days and regardless of whether the transferring hospital anticipates that this SNF stay will be covered by Medicare. WebThe disposition, or location to which the patient is transferred at the time of hospital discharge. 2730 0 obj <> endobj startxref CMS If you do not agree to the terms and conditions, you may not access or use the software. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING. Print | a. Discharged to home under a home health agency with durable medical equipment (DME). If providers are not sure whether a facility is a LTCH or a short-term care hospital, they should contact the facility to verify their facility type before assigning a patient discharge status code. 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. %%EOF 05 Discharged/Transferred to Another Type of Health Care Institution Not Defined Elsewhere in This Code List 0000003442 00000 n It is important to select the correct Patient Discharge Status code. discharge disposition codes 08. or ** The first digit is a leading zero. WebCodesystem-encounter-discharge-disposition - FHIR v4.3.0 Terminology Code Systems This page is part of the FHIR Specification (v4.3.0: R4B - STU ). ["Discharge Disposition": "Discharge To Acute Care Facility"] There is no FY 2023 GEMs file. Routine or Continuous Home Care Patient discharge status code 50: Hospice home should be used if the patient went to his/her own home or an alternative setting that is the patients home, such as a nursing facility, and will receive in-home hospice services; General Inpatient Care Patient discharge status code 51: Hospice medical facility should be used if the patient went to an inpatient facility that is qualified and the patient is to receive the general inpatient hospice level of care; and. endstream endobj 2731 0 obj <>/Metadata 86 0 R/Outlines 119 0 R/PageLabels 2722 0 R/PageLayout/OneColumn/Pages 2724 0 R/PieceInfo<>>>/StructTreeRoot 133 0 R/Type/Catalog>> endobj 2732 0 obj <>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/StructParents 0/Type/Page>> endobj 2733 0 obj <>stream ~``P(p#mC??``dR/6d`` = _= `qs@G2201= O Official websites use .govA The hospital must have an effective discharge planning process that focuses on the patient's goals and treatment preferences and includes the patient and his or her caregivers/support person(s) as active partners in the discharge planning for post-discharge care. wKb${aY]YlYwKr{l."T-g3q,$I=hS!b ;fj5Ku{:m3>g'9?0"y*Ieo&5qMHtZT`;QA]Uv|:Z{9,VGk,}D=aS&=JE(e;J)yXHUB3'SqM`}tu;nvkuO?O%Fi X. Discharged/transferred to a facility that provides custodial or supportive care. if(pathArray[4]){document.getElementById("usprov").href="/web/"+pathArray[4]+"/help/us-government-rights";} The fourth digit is indicative of the submission frequency, and should align with the Patient Discharge Status reported on the claim. This includes items such as CPT codes, CDT codes, ICD-10 and other UB-04 codes. Warning: you are accessing an information system that may be a U.S. Government information system. You may also contact AHA at ub04@healthforum.com. We made the GEMs files available for FY 2016, FY 2017 and FY 2018. The level of care the patient is receiving; and Clinical Focus: This value set contains concepts that represent a patient leaving against medical advice. + | 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. Additionally, a type of bill reflective of a discharge or final claim should be reported with a Patient Discharge Status 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). Webwhich tools would you use to make header 1 look like header 2 2021 CODE:307.2.1.1 Condensate discharge. Cms discharge planning rule: are you To license the electronic data file of UB-04 Data Specifications, contact AHA at (312) 893-6816. 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. WebClick here for Clinical Engineering Services (BioMed) eCovenant IT. 43 Discharged/Transferred to a Federal Hospital This Agreement will terminate upon notice if you violate its terms. The sole responsibility for the software, including any CDT and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. Making copies or utilizing the content of the UB-04 Manual or UB-04 Data File, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual / Data File or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association.
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cms discharge disposition codes 2021