COLORADO PATIENT DISCHARGE STATUS TOOLKIT

COLORADO PATIENT DISCHARGE STATUS TOOLKIT FOR INPATIENT DISCHARGES EFFECTIVE October 1, 2014 Tedi Lojewski, RHIA, CCS, CHDA, Editor CHIMA Data Quality Committee Revised October 2014

COLORADO PATIENT DISCHARGE STATUS TOOLKIT Table of Contents Document # Description 01 Introduction 02 Patient s 03 Colorado Facilities - Category 04 Colorado Facilities - Alphabetic 05 References

Document 01 INTRODUCTION CHIMA gratefully acknowledges the invaluable contributions of Sue M. Malone, MA, MBA, RHIA, FAHIMA, the developer and editor of previous editions of the Colorado Reference Sheet for Patient s for Inpatient s. The first reference sheet was made available to Colorado hospitals through the collaboration of the Colorado Hospital Association (CHA) and the Colorado Health Information Management Association (CHIMA) in 2000. It was developed as a tool for hospital coding staff to facilitate accurate assignment of inpatient discharge status codes, accurate and consistent data submission for the CHA database, and submission of billing data in compliance with applicable laws and regulations. The patient discharge status is required on all institutional claims. A basic rule of thumb is to code to the highest level of care known. Accurate reporting of the patient discharge status code is essential for appropriate reimbursement. Under the Medicare Post Acute Care Transfer (PACT) policy for the inpatient prospective payment system (IPPS), a hospital inpatient discharge is considered to be a transfer when the patient is discharged to another short-term general hospital. The discharge is also considered a transfer when the patient is assigned to a qualifying MS-DRG and the discharge is made under one of the following circumstances: to a hospital or distinct part hospital unit excluded from the IPPS, to a skilled nursing facility (not swing beds), or to home with home health services. The PACT policy establishes reduced reimbursement for patient transfers, which are identified by the patient discharge status code. The blue italicized text is text taken directly from the NUBC Official UB-04 Data Specifications Manual 2015, Version 9.00, July 2014. Additional information not in italicized text was added by the editor. This toolkit is for inpatient discharges only there are additional discharge status codes for other types of discharges, such as discharges from outpatient, hospice, and other categories which have not been included here. For the 2014 revision, facility listings have been moved from the Patient document to two separate tables, one by category/patient discharge status code (Document 03) and one alphabetical (Document 04). The facility listings are identical in content other than their sort order. The facility listings do not include general hospitals, Medicare-certified skilled nursing facilities, or home health agencies due to the volume of facilities in each of these categories. For a full listing of facilities and licensure status, go to the Colorado Department of Public Health and Environment (CDPHE) website at: https://www.colorado.gov/pacific/cdphe/facility-directory-city-and-county Colorado licensure status for healthcare facilities is a constantly moving target. The listings of facilities in Documents 03 and 04 are correct to the best of our knowledge at the time of publication, but changes can occur at any time. To verify current information, access the above CDPHE website and follow the search directions for the type of health care facility. Please report any item that needs correction to the editor or the CHIMA office coordinator (see References document for contact information). Revised October 2014 Page 3

Document 02 PATIENT DISCHARGE STATUS CODES FOR INPATIENT DISCHARGES EFFECTIVE OCTOBER 1, 2014 1 NUBC Definition NUBC Usage Note / CHIMA Note PACT 2 01 81 d to Home or Self Care (Routine ) Includes discharge to home; home on oxygen if DME only; any other DME only; group home, foster care, independent living and other residential care arrangements; outpatient programs, such as partial hospitalization or outpatient chemical dependency programs. No 02 82 d/transferred to a Short-Term General Hospital See the CDPHE website for a current listing of general hospitals in Yes for Inpatient Care Colorado. Includes transfers to non-designated children's hospitals and cancer centers. The Children's Hospital at Memorial Hospital (Colorado Springs) and Rocky Mountain Hospital for Children (Denver) are non-designated and should be assigned Code 02. For designated children's hospitals and designated cancer center hospitals, see Code 05. 03 83 d/transferred to Skilled Nursing Facility (SNF) with Medicare Certification in Anticipation of Skilled Care It is important to identify the appropriate code for SNF transfers, as only Code 03 has potential for reduced reimbursement. See the CDPHE website for a current listing of SNFs and their certification status. See Code 04 for SNF that is neither Medicare nor Medicaid certified (private pay only). See Code 61 for skilled nursing in an approved Swing Bed. See Code 64 for SNF that is Medicaid certified only. Yes Revised October 2014 Page 4

Document 02 PATIENT DISCHARGE STATUS CODES FOR INPATIENT DISCHARGES EFFECTIVE OCTOBER 1, 2014 1 NUBC Definition NUBC Usage Note / CHIMA Note PACT 2 04 84 d/transferred to a Facility that Provides Custodial or Supportive Care Includes intermediate care facilities (ICFs) if specifically designated at the state level. Also used to designate patients that are discharged/transferred to a nursing facility (SNF) with neither Medicare nor Medicaid certification (i.e., private pay) and for discharges/transfers to Assisted Living Facilities (ALFs). ICF: See Document 03, category ICF, for a Colorado listing. SNF: See Document 03, category SNFPP, for a listing of Colorado private pay SNFs. See the CDPHE website for a current listing of all SNFs and their certification status. ALF: See the CDPHE website for a current listing of licensed Assisted Living Residences. If home care services are provided within the ALF, use Code 06. If hospice has been elected, use the hospice rules for Codes 50 and 51. RTF: See the CDPHE website under Assited Living Residences for a current list of licensed Residential Treatment Facilities for the Mentally Ill. The State of Colorado categorizes these as Assisted Living Residences. No Revised October 2014 Page 5

Document 02 PATIENT DISCHARGE STATUS CODES FOR INPATIENT DISCHARGES EFFECTIVE OCTOBER 1, 2014 1 NUBC Definition NUBC Usage Note / CHIMA Note PACT 2 05 85 d/transferred to a Designated Cancer Center or Transfers to non-designated cancer hospitals should use Code 02. A Yes Children's Hospital list of National Cancer Institute Designated Cancer Centers by State can be found at cancercenters.cancer.gov/cancer_centers/cancercenters-list2.html. As of this update, the only designated Cancer Center in Colorado is University of Colorado Cancer Center, Denver. Transfers to non-designated hospitals should use Code 02. Designated children's hospitals are separately certified by Medicare as children's hospitals. As of this update, the only designated children's hospital in Colorado is Children's Hospital Colorado. Transfers to all other non-designated children's hospitals should use Code 02. Neither Children's Hospital Colorado South Campus (Highlands Ranch) or Children's Hospital at Memorial Hospital Central (Colorado Springs) are certified as children's hospitals - use 02. 06 86 d/transferred to Home Under Care of an Organized Home Health Service Organization in Anticipation of Covered Skilled Care Report this code when the patient is discharged/transferred to home with a written plan of care for home care services. Not used for home health services provided by a DME supplier or from a Home IV provider for home IV services (use Code 01). Append condition code 42 if the home care is not related to the inpatient stay. Append condition code 43 if the home care services are not started within 3 days of discharge. Medicare reimbursement is not reduced when condition code 42 or 43 are assigned. See the CDPHE website for a current listing of licensed Home Health agencies. Yes Revised October 2014 Page 6

Document 02 PATIENT DISCHARGE STATUS CODES FOR INPATIENT DISCHARGES EFFECTIVE OCTOBER 1, 2014 1 NUBC Definition NUBC Usage Note / CHIMA Note PACT 2 07 Left Against Medical Advice (AMA) or Discontinued Care If a Medicare patient is admitted to another hospital on the same day the patient leaves AMA, Medicare will retroactively change the discharge status to Code 02 and potentially reduce payment. No 20 Expired No 21 87 d/transferred to Court/Law Enforcement Includes transfers to incarceration facilities such as jail, prison or No other detention facilities. Includes local and county jails, state and federal correctional institutions. See Document 03, category LAW, for a listing of State and Federal correctional facilities in Colorado. Colorado Department of Corrections facilities are also listed at: http://www.doc.state.co.us/colorado-department-correctionsfacilities 30 Still Patient Used when patient is still within the same facility. Typically used when billing for leave of absence days or interim bills. No 43 88 d/transferred to a Federal Health Care Facility s and transfers to a government operated health facility such as a Department of Defense hospital, a Veteran's Administration hospital or a Veteran's Administration nursing facility. To be used whenever the destination at discharge is a federal health care facility, whether the patient lives there or not. No 50 Hospice - Home Once a patient accepts the hospice benefit, the correct assignment is Code 50 if the patient is returning home with home hospice care. If the patient only has a hospice referral but has not actually made the hospice election, use Code 01. No Revised October 2014 Page 7

Document 02 PATIENT DISCHARGE STATUS CODES FOR INPATIENT DISCHARGES EFFECTIVE OCTOBER 1, 2014 1 NUBC Definition NUBC Usage Note / CHIMA Note PACT 2 51 Hospice - Medical Facility (Certified) Providing Hospice Level of Care Once a patient accepts the hospice benefit, the correct assignment is Code 51 if the patient is discharged to a certified medical facility providing hospice care (e.g., hospital, nursing home, inpatient hospice unit). Do not use if the patient has a hospice referral but has not actually made the hospice election. No 61 89 d/transferred to a Hospital-Based Medicare Approved Swing Bed 62 90 d/transferred to an Inpatient Rehabilitation Facility (IRF) including Rehbilitation Distinct Part Units of a Hospital 63 91 d/transferred to a Medicare Certified Long Term Care Hospital (LTCH) 64 92 d/transferred to a Nursing Facility Certified under Medicaid but not Certified under Medicare Medicare - Used for reporting patients discharged/transferred to a SNF level of care within the hospital's approved swing bed arrangement. Swing bed refers to an approved Medicare arrangement under which certain small, rural hospitals can use its beds, as needed, to provide either acute or SNF-level care. Swing beds are frequently, but not always, located in CAHs. See Document 03, category SWING, for a listing of Colorado hospitals with Medicare approved swing beds. See Document 03, category IRF, for a listing of IRF hospitals and hospital units in Colorado. Several units have closed since the 2011 revision. For hospitals that meet the Medicare criteria for LTCH certification. See Document 03, category SNFMA, for a listing of Colorado Medicaid-only SNFs. See the CDPHE website for a current listing of all SNFs and their certification status. No Yes Yes No Revised October 2014 Page 8

Document 02 PATIENT DISCHARGE STATUS CODES FOR INPATIENT DISCHARGES EFFECTIVE OCTOBER 1, 2014 1 NUBC Definition NUBC Usage Note / CHIMA Note PACT 2 65 93 d/transferred to a Psychiatric Hospital (IPF) or Includes discharge for inpatient services only. Does not include Yes Psychiatric Distinct Part Unit of a Hospital outpatient psychiatric services (use Code 01). If the psychiatric unit is not a designated distinct part unit with a separate Medicare provider number, use Code 02. See Document 03, category IPF, for a listing of IPF hospitals and hospital units in Colorado. Several units have closed since the 2011 revision. 66 94 d/transferred to a Critical Access Hospital (CAH) CAHs are limited service hospitals located in rural areas. They provide 24 hour emergency services, have an average length of stay of 96 hours or less, and are located more than 35 miles from a hospital or more than 15 miles in areas with mountainous terrain or only secondary roads OR are certified by the State as being a "necessary provider" of healthcare services to residents in the area. CAHs are excluded from the inpatient and outpatient prospective payment systems and are paid on a cost-plus basis. Swing beds are often located in CAHs. If the discharge is to a swing bed, use Code 61. If the discharge is to acute care, use Code 66. See Document 03, category CAH, for a listing of Colorado CAHs. No 69 d/transferredto a Designated Disaster Alternative Care Site New code effective 10/1/13 Alternative Care Sites (ACSs) provide basic patient care during a disaster response to a population that would otherwise be hospitalized or in a similar level of dependent care if those resources were available during the disaster. The opening of an ACS is a last resourt when disaster incident demands have overwhelmed the hospitals' surge capacity. The trigger is a governor or federal declared disaster; it is not arbitrary. ACS services are considered outpatient. No Revised October 2014 Page 9

Document 02 PATIENT DISCHARGE STATUS CODES FOR INPATIENT DISCHARGES EFFECTIVE OCTOBER 1, 2014 1 NUBC Definition NUBC Usage Note / CHIMA Note PACT 2 70 95 d/transferred to another Type of Health Care Institution not Defined Elsewhere in this Code List Code 70 ws created to be an "other" default code. It should be used only for services provded on an inpatient basis that do not fall under another code in this list. An example of usage is a live-in drug/chemical dependency rehabilitation center (but if it were an outpatient chemical dependency center use Code 01). See Document 03, category OTHER, for a listing of known facilities. Coders are requested to report additional specific facilities to the editor or the CHIMA central office. No 1 New Patient Status codes effective October 1, 2013 The NUBC approved 15 new patient discharge status codes (81-95) adapted from existing codes with "a Planned Acute Care Hospital Inpatient " appended in the title. "" is defined as "An intential readmission after discharge from an acute care hospital that is a scheduled part of the patient's plan of care." These codes apply to the original discharge claim. A readmission is expected according to (and as documented in) the patient s discharge plan. No time frame (between discharge and readmission) is specified in the definition of planned readmission. Effective for discharges from an acute care hospital on or after October 1, 2013. 2 PACT Post Acute Care Transfer Policy Yes = This discharge status code indicates a transfer under the Medicare PACT policy and may result in reduced Medicare reimbursement for most MS-DRGs. (Patient discharge status codes 02, 03, 05, 06, 62, 63 and 65) No = This discharge status code does not impact reimbursement to the discharging hospital. Revised October 2014 Page 10

Document 03 COLORADO FACILITIES - CATEGORY This listing does not include general hospitals (Code 02), home health agencies (Code 06), Medicare certified Skilled Nursing Facilities (Code 03), Assisted Living Facilities and Residential Treatment Facilities for the Mentally Ill (Code 04). For a current, complete listing see the Colorado Department of Public Health & Environment (CDPHE) website at: https://www.colorado.gov/pacific/cdphe/facility-directory-city-and-county Children's Hospital Colorado South Campus Highlands Ranch ACUTE 02 82 Rocky Mountain Hospital for Children (Presbyterian-St. Luke's) Denver ACUTE 02 82 University of Colorado Health at Memorial Hospital Central - Children's Hospital Colorado Springs ACUTE 02 82 Bethesda Lutheran Communities - Caley Drive Home Littleton ICF 04 84 Bethesda Lutheran Communities - Delaware Circle Home Littleton ICF 04 84 Bethesda Lutheran Communities - Sherman Street Home Centennial ICF 04 84 Bethesda Lutheran Communities - Wellington Street Home Centennial ICF 04 84 Grand Junction Regional Center (State of Colorado) Grand Junction ICF 04 84 Wheat Ridge Regional Center - 105th Place Broomfield ICF 04 84 Wheat Ridge Regional Center - 49th House Golden ICF 04 84 Wheat Ridge Regional Center - 53rd Street Denver ICF 04 84 Wheat Ridge Regional Center - 59th House Golden ICF 04 84 Wheat Ridge Regional Center - 67th Group Home Arvada ICF 04 84 Wheat Ridge Regional Center - 68th House Arvada ICF 04 84 Wheat Ridge Regional Center - Depew Denver ICF 04 84 Wheat Ridge Regional Center - Independence Lakewood ICF 04 84 Wheat Ridge Regional Center - Iris House Arvada ICF 04 84 Wheat Ridge Regional Center - Kipling Village Wheat Ridge ICF 04 84 Wheat Ridge Regional Center - Lamar Arvada ICF 04 84 Wheat Ridge Regional Center - Nelson Lakewood ICF 04 84 Wheat Ridge Regional Center - Perry Denver ICF 04 84 Wheat Ridge Regional Center - Secrest House Arvada ICF 04 84 Wheat Ridge Regional Center - Xenon Golden ICF 04 84 Revised October 2014 Page 11

Document 03 COLORADO FACILITIES - CATEGORY Aspen Siesta Denver SNFPP 04 84 Balfour Retirement Community of Boulder County Louisville SNFPP 04 84 Center at Cordera, The Colorado Springs SNFPP 04 84 Englewood Meridian Health Center Englewood SNFPP 04 84 Lakewood Meridian Health Center Lakewood SNFPP 04 84 Wide Horizon Inc. Wheat Ridge SNFPP 04 84 University of Colorado Cancer Center Denver CA 05 85 Children's Hospital Colorado Aurora CHILD 05 85 Colorado Department of Corrections Facilities Colorado locations LAW 21 87 http://www.doc.state.co.us/colorado-department-corrections-facilities Federal Correctional Institution - Englewood Englewood LAW 21 87 Federal Correctional Institution - Florence Florence LAW 21 87 U.S. Penitentiary and Administrative Maximum Facility Florence LAW 21 87 Colorado State Veterans Nursing Home - Bruce McCandless Florence FED 43 88 Colorado State Veterans Nursing Home - Homelake Monte Vista FED 43 88 Colorado State Veterans Nursing Home - Rifle Rifle FED 43 88 Colorado State Veterans Nursing Home - Walsenburg Walsenburg FED 43 88 Colorado State Veterans Nursing Home at Fitzsimons Aurora FED 43 88 Evans Army Community Hospital - U.S. Army Fort Carson FED 43 88 VA Medical Center - Denver Denver FED 43 88 VA Medical Center - Grand Junction Grand Junction FED 43 88 VA Nursing Home - Denver Denver FED 43 88 VA Nursing Home - Pueblo Pueblo FED 43 88 Aspen Valley Hospital - Swing Bed Aspen SWING 61 89 Centura Health - St. Thomas More Hospital - Swing Beds Canon City SWING 61 89 Colorado Canyons Hospital and Medical Center - Swing Bed Fruita SWING 61 89 Colorado Plains Medical Center - Swing Bed Fort Morgan SWING 61 89 East Morgan County Hospital District - Swing Bed Brush SWING 61 89 Estes Park Medical Center - Swing Bed Estes Park SWING 61 89 Revised October 2014 Page 12

Document 03 COLORADO FACILITIES - CATEGORY Grand River Medical Center - Swing Bed Rifle SWING 61 89 Gunnison Valley Hospital - Swing Bed Gunnison SWING 61 89 Haxtun Hospital - Swing Bed Haxtun SWING 61 89 Heart of the Rockies Regional Medical Center - Swing Bed Salida SWING 61 89 Keefe Memorial Hospital - Swing Bed Cheyenne Wells SWING 61 89 Kit Carson County Memorial Hospital - Swing Bed Burlington SWING 61 89 Lincoln Community Hospital - Swing Bed Hugo SWING 61 89 Melissa Memorial Hospital - Swing Bed Holyoke SWING 61 89 Memorial Hospital, The - Swing Bed Craig SWING 61 89 Middle Park Medical Center - Swing Bed Kremmling SWING 61 89 Mt. San Rafael Hospital - Swing Bed Trinidad SWING 61 89 Pikes Peak Regional Hospital - Swing Bed Woodland Park SWING 61 89 Pioneers Medical Center - Swing Bed Meeker SWING 61 89 Prowers Medical Center - Swing Bed Lamar SWING 61 89 Rangely District Hospital - Swing Bed Rangley SWING 61 89 Rio Grande Hospital - Swing Bed Del Norte SWING 61 89 San Luis Valley Health - Swing Bed Alamosa SWING 61 89 San Luis Valley Health Conejos County Hospital - Swing Bed La Jara SWING 61 89 Sedgwick County Memorial Hospital - Swing Bed Julesburg SWING 61 89 Southeast Colorado Hospital - Swing Bed Springfield SWING 61 89 Southwest Memorial Hospital- Swing Bed Cortez SWING 61 89 Spanish Peaks Regional Health Center - Swing Bed Walsenburg SWING 61 89 St. Anthony Summit Medical Center - Swing Bed Frisco SWING 61 89 St. Vincent General Hospital District - Swing Bed Leadville SWING 61 89 Weisbrod Memorial County Hospital - Swing Bed Eads SWING 61 89 Wray Community District Hospital - Swing Bed Wray SWING 61 89 Yampa Valley Medical Center - Swing Bed Steamboat Springs SWING 61 89 Yuma District Hospital - Swing Bed Yuma SWING 61 89 Revised October 2014 Page 13

Document 03 COLORADO FACILITIES - CATEGORY Boulder Community Hospital - Rehab Unit Boulder IRF 62 90 Centura Health - Littleton Adventist Hospital - Rehab Unit Littleton IRF 62 90 Centura Health - Penrose-St. Francis Health Services - Rehab Unit Colorado Springs IRF 62 90 Centura Health - Porter Adventist Hospital - Rehab Unit Denver IRF 62 90 Centura Health - St. Anthony Hospital - Rehab Unit Lakewood IRF 62 90 Centura Health - St. Mary Corwin Medical Center - Rehab Unit Pueblo IRF 62 90 Denver Health Medical Center - Rehab Unit Denver IRF 62 90 HealthSouth Rehabilitation Hospital of Colorado Springs Colorado Springs IRF 62 90 HealthSouth Rehabilitation Hospital of Littleton Littleton IRF 62 90 Medical Center of the Rockies - Rehab Unit Loveland IRF 62 90 Montrose Memorial Hospital - Rehab Unit Montrose IRF 62 90 North Colorado Medical Center - Rehab Unit Greeley IRF 62 90 Northern Colorado Rehabilitation Hospital Johnstown IRF 62 90 Parkview Medical Center - Rehab Unit Pueblo IRF 62 90 Spalding Rehabilitation Hospital Aurora IRF 62 90 St. Mary's Hospital and Medical Center - Rehab Unit Grand Junction IRF 62 90 Swedish Medical Center - Rehab Unit Englewood IRF 62 90 University of Colorado Health at Memorial Hospital Central - Rehab Unit Colorado Springs IRF 62 90 University of Colorado Hospital Anschutz Inpatient Pavilion - Rehab Unit Denver IRF 62 90 Colorado Acute Long Term Hospital Denver LTCH 63 91 Craig Hospital Englewood LTCH 63 91 Kindred Hospital - Aurora Aurora LTCH 63 91 Kindred Hospital - Denver Denver LTCH 63 91 Northern Colorado Long Term Acute Hospital Johnstown LTCH 63 91 Select Long Term Care Hospital - Colorado Springs Colorado Springs LTCH 63 91 Select Specialty Hospital - Denver (located at PSL) Denver LTCH 63 91 Select Specialty Hospital - Denver South Campus (located at PAH) Denver LTCH 63 91 Vibra Long Term Acute Care Hospital Thornton LTCH 63 91 Centura Health - Namaste Alzheimer Center Colorado Springs SNFMA 64 92 Revised October 2014 Page 14

Document 03 COLORADO FACILITIES - CATEGORY Cheyenne Manor Cheyenne Wells SNFMA 64 92 Courtyard Care Center Fruita SNFMA 64 92 Good Samaritan Society Simla Simla SNFMA 64 92 Little Sisters of the Poor Mullen Home Denver SNFMA 64 92 Park Forest Care Center, Inc. Westminster SNFMA 64 92 Pikes Peak Center Colorado Springs SNFMA 64 92 Sedgwick County Memorial Nursing Home Julesburg SNFMA 64 92 Southeast Colorado Hospital LTC Center Springfield SNFMA 64 92 Spanish Peaks Veterans Community Living Center Walsenburg SNFMA 64 92 Walsh Healthcare Center Walsh SNFMA 64 92 Boulder Community Hospital - Psych Unit Boulder IPF 65 93 Cedar Springs Behavioral Health System Colorado Springs IPF 65 93 Centennial Peaks Hospital Louisville IPF 65 93 Centura Health - Porter Adventist Hospital - Psych Unit Denver IPF 65 93 Colorado Mental Health Institute at Ft. Logan Ft. Logan IPF 65 93 Colorado Mental Health Institute at Pueblo Pueblo IPF 65 93 Colorado Plains Medical Center - Psych Unit Fort Morgan IPF 65 93 Colorado West Psychiatric Hospital Inc. Grand Junction IPF 65 93 Denver Health Medical Center - Psych Unit Denver IPF 65 93 Eating Recovery Center - A Behavioral Hospital (Franklin St) Denver IPF 65 93 Eating Recovery Center - A Behavioral Hospital for Children and Adolescents Denver IPF 65 93 Eating Recovery Center Behavioral Health (Spruce St) Denver IPF 65 93 Exempla Lutheran Medical Center - West Pines Wheat Ridge IPF 65 93 Haven Behavioral Hospital of Southern Colorado Pueblo IPF 65 93 Highlands Behavioral Health System Littleton IPF 65 93 Medical Center of Aurora, The - Psych Unit Aurora IPF 65 93 Parkview Medical Center - Psych Unit Pueblo IPF 65 93 Peak View Behavioral Health Colorado Springs IPF 65 93 Poudre Valley Hospital - Psych Unit Ft. Collins IPF 65 93 Revised October 2014 Page 15

Document 03 COLORADO FACILITIES - CATEGORY Aspen Valley Hospital Aspen CAH 66 94 Colorado Canyons Hospital and Medical Center Fruita CAH 66 94 East Morgan County Hospital District Brush CAH 66 94 Estes Park Medical Center Estes Park CAH 66 94 Grand River Medical Center Rifle CAH 66 94 Gunnison Valley Hospital Gunnison CAH 66 94 Haxtun Hospital District Haxtun CAH 66 94 Heart of the Rockies Regional Medical Center Salida CAH 66 94 Kit Carson County Memorial Hospital Burlington CAH 66 94 Lincoln Community Hospital Hugo CAH 66 94 Melissa Memorial Hospital Holyoke CAH 66 94 Memorial Hospital, The Craig CAH 66 94 Middle Park Medical Center Kremmling CAH 66 94 Mt. San Rafael Hospital Trinidad CAH 66 94 Pagosa Springs Medical Center Pagosa Springs CAH 66 94 Pikes Peak Regional Hospital Woodland Park CAH 66 94 Pioneers Medical Center Meeker CAH 66 94 Prowers Medical Center Lamar CAH 66 94 Rangely District Hospital Rangely CAH 66 94 Rio Grande Hospital Del Norte CAH 66 94 San Luis Valley Health Conejos County Hospital La Jara CAH 66 94 Sedgwick County Memorial Hospital Julesburg CAH 66 94 Southeast Colorado Hospital Springfield CAH 66 94 Southwest Memorial Hospital Cortez CAH 66 94 Spanish Peaks Regional Health Center Walsenburg CAH 66 94 St. Vincent General Hospital District Leadville CAH 66 94 Weisbrod Memorial County Hospital Eads CAH 66 94 Wray Community District Hospital Wray CAH 66 94 Yuma District Hospital Yuma CAH 66 94 Revised October 2014 Page 16

Document 03 COLORADO FACILITIES - CATEGORY Arapahoe House - Aurora Emergency Treatment Unit Aurora OTHER 70 95 Arapahoe House - Detox North Commerce City OTHER 70 95 Arapahoe House - Detox West Wheat Ridge OTHER 70 95 Arapahoe House - Thornton (residential treatment center) Thornton OTHER 70 95 CeDAR (Center for Dependency, Addition & Rehab - CU) - residential treatment ctr Denver OTHER 70 95 Harmony House (residential treatment center) Estes Park OTHER 70 95 Serenity @ Stout Street (residential treatment center) Commerce City OTHER 70 95 Sobriety House, Inc. (residential treatment center) Denver OTHER 70 95 Valley Hope Drug Rehab Center - Denver South (inpatient drug rehabilitation) Centennial OTHER 70 95 Valley Hope Drug Rehab Center - Parker (inpatient drug rehabilitation) Parker OTHER 70 95 Weisbrod Memorial County Hospital Extended Care Unit (no Colorado Nursing Home licensure as of this update; considered residential) Eads HOME 01 81 Legend: Category ACUTE = Acute care general hospital CA = Designated cancer hospital CAH = Critical Access Hospital CHILD = Medicare certified children's hospital FED = Federal government operated health facility ICF = Intermediate care facility for mentally retarded IPF = Medicare certified inpatient psychiatric facility IRF = Medicare certified inpatient rehabilitation facility LAW = Law enforcement facility LTCH = Medicare certified long term care hospital OTHER = Not defined elsewhere (inpatient drug/alcohol facility) SNFPP = Private pay skilled nursing facility SNFMA = Medicaid-only certified skilled nursing facility SWING = Medicare approved swing bed Revised October 2014 Page 17

Document 03 COLORADO FACILITIES - CATEGORY Legend: New codes effective October 1, 2013 The NUBC approved 15 new patient discharge status codes (81-95) adapted from existing codes with "a Planned Acute Care Hospital Inpatient " appended in the title. "" is defined as "An intential readmission after discharge from an acute care hospital that is a scheduled part of the patient's plan of care." These codes apply to the original discharge claim. A readmission is expected according to (and as documented in) the patient s discharge plan. No time frame (between discharge and readmission) is specified in the definition of planned readmission. Effective for discharges from an acute care hospital on or after October 1, 2013. Revised October 2014 Page 18

Document 04 COLORADO FACILITIES - ALPHABETIC This listing does not include general hospitals (Code 02), home health agencies (Code 06), Medicare certified Skilled Nursing Facilities (Code 03), Assisted Living Facilities and Residential Treatment Facilities for the Mentally Ill (Code 04). For a current, complete listing see the Colorado Department of Public Health & Environment (CDPHE) website at: https://www.colorado.gov/pacific/cdphe/facility-directory-city-and-county Arapahoe House - Aurora Emergency Treatment Unit Aurora OTHER 70 95 Arapahoe House - Detox North Commerce City OTHER 70 95 Arapahoe House - Detox West Wheat Ridge OTHER 70 95 Arapahoe House - Thornton (residential treatment center) Thornton OTHER 70 95 Aspen Siesta Denver SNFPP 04 84 Aspen Valley Hospital Aspen CAH 66 94 Aspen Valley Hospital - Swing Bed Aspen SWING 61 89 Balfour Retirement Community of Boulder County Louisville SNFPP 04 84 Bethesda Lutheran Communities - Caley Drive Home Littleton ICF 04 84 Bethesda Lutheran Communities - Delaware Circle Home Littleton ICF 04 84 Bethesda Lutheran Communities - Sherman Street Home Centennial ICF 04 84 Bethesda Lutheran Communities - Wellington Street Home Centennial ICF 04 84 Boulder Community Hospital - Psych Unit Boulder IPF 65 93 Boulder Community Hospital - Rehab Unit Boulder IRF 62 90 CeDAR (Center for Dependency, Addition & Rehab - CU) - residential treatment ctr Denver OTHER 70 95 Cedar Springs Behavioral Health System Colorado Springs IPF 65 93 Centennial Peaks Hospital Louisville IPF 65 93 Center at Cordera, The Colorado Springs SNFPP 04 84 Centura Health - Littleton Adventist Hospital - Rehab Unit Littleton IRF 62 90 Centura Health - Namaste Alzheimer Center Colorado Springs SNFMA 64 92 Centura Health - Penrose-St. Francis Health Services - Rehab Unit Colorado Springs IRF 62 90 Centura Health - Porter Adventist Hospital - Psych Unit Denver IPF 65 93 Centura Health - Porter Adventist Hospital - Rehab Unit Denver IRF 62 90 Revised October 2014 Page 19

Document 04 COLORADO FACILITIES - ALPHABETIC Centura Health - St. Anthony Hospital - Rehab Unit Lakewood IRF 62 90 Centura Health - St. Mary Corwin Medical Center - Rehab Unit Pueblo IRF 62 90 Centura Health - St. Thomas More Hospital - Swing Beds Canon City SWING 61 89 Cheyenne Manor Cheyenne Wells SNFMA 64 92 Children's Hospital Colorado Aurora CHILD 05 85 Children's Hospital Colorado South Campus Highlands Ranch ACUTE 02 82 Colorado Acute Long Term Hospital Denver LTCH 63 91 Colorado Canyons Hospital and Medical Center Fruita CAH 66 94 Colorado Canyons Hospital and Medical Center - Swing Bed Fruita SWING 61 89 Colorado Department of Corrections Facilities Colorado locations LAW 21 87 http://www.doc.state.co.us/colorado-department-corrections-facilities Colorado Mental Health Institute at Ft. Logan Ft. Logan IPF 65 93 Colorado Mental Health Institute at Pueblo Pueblo IPF 65 93 Colorado Plains Medical Center - Psych Unit Fort Morgan IPF 65 93 Colorado Plains Medical Center - Swing Bed Fort Morgan SWING 61 89 Colorado State Veterans Nursing Home - Bruce McCandless Florence FED 43 88 Colorado State Veterans Nursing Home - Homelake Monte Vista FED 43 88 Colorado State Veterans Nursing Home - Rifle Rifle FED 43 88 Colorado State Veterans Nursing Home - Walsenburg Walsenburg FED 43 88 Colorado State Veterans Nursing Home at Fitzsimons Aurora FED 43 88 Colorado West Psychiatric Hospital Inc. Grand Junction IPF 65 93 Courtyard Care Center Fruita SNFMA 64 92 Craig Hospital Englewood LTCH 63 91 Denver Health Medical Center - Psych Unit Denver IPF 65 93 Denver Health Medical Center - Rehab Unit Denver IRF 62 90 East Morgan County Hospital District Brush CAH 66 94 East Morgan County Hospital District - Swing Bed Brush SWING 61 89 Eating Recovery Center - A Behavioral Hospital (Franklin St) Denver IPF 65 93 Eating Recovery Center - A Behavioral Hospital for Children and Adolescents Denver IPF 65 93 Revised October 2014 Page 20

Document 04 COLORADO FACILITIES - ALPHABETIC Eating Recovery Center Behavioral Health (Spruce St) Denver IPF 65 93 Englewood Meridian Health Center Englewood SNFPP 04 84 Estes Park Medical Center Estes Park CAH 66 94 Estes Park Medical Center - Swing Bed Estes Park SWING 61 89 Evans Army Community Hospital - U.S. Army Fort Carson FED 43 88 Exempla Lutheran Medical Center - West Pines Wheat Ridge IPF 65 93 Federal Correctional Institution - Englewood Englewood LAW 21 87 Federal Correctional Institution - Florence Florence LAW 21 87 Good Samaritan Society Simla Simla SNFMA 64 92 Grand Junction Regional Center (State of Colorado) Grand Junction ICF 04 84 Grand River Medical Center Rifle CAH 66 94 Grand River Medical Center - Swing Bed Rifle SWING 61 89 Gunnison Valley Hospital Gunnison CAH 66 94 Gunnison Valley Hospital - Swing Bed Gunnison SWING 61 89 Harmony House (residential treatment center) Estes Park OTHER 70 95 Haven Behavioral Hospital of Southern Colorado Pueblo IPF 65 93 Haxtun Hospital - Swing Bed Haxtun SWING 61 89 Haxtun Hospital District Haxtun CAH 66 94 HealthSouth Rehabilitation Hospital of Colorado Springs Colorado Springs IRF 62 90 HealthSouth Rehabilitation Hospital of Littleton Littleton IRF 62 90 Heart of the Rockies Regional Medical Center Salida CAH 66 94 Heart of the Rockies Regional Medical Center - Swing Bed Salida SWING 61 89 Highlands Behavioral Health System Littleton IPF 65 93 Keefe Memorial Hospital - Swing Bed Cheyenne Wells SWING 61 89 Kindred Hospital - Aurora Aurora LTCH 63 91 Kindred Hospital - Denver Denver LTCH 63 91 Kit Carson County Memorial Hospital Burlington CAH 66 94 Kit Carson County Memorial Hospital - Swing Bed Burlington SWING 61 89 Lakewood Meridian Health Center Lakewood SNFPP 04 84 Revised October 2014 Page 21

Document 04 COLORADO FACILITIES - ALPHABETIC Lincoln Community Hospital Hugo CAH 66 94 Lincoln Community Hospital - Swing Bed Hugo SWING 61 89 Little Sisters of the Poor Mullen Home Denver SNFMA 64 92 Medical Center of Aurora, The - Psych Unit Aurora IPF 65 93 Medical Center of the Rockies - Rehab Unit Loveland IRF 62 90 Melissa Memorial Hospital Holyoke CAH 66 94 Melissa Memorial Hospital - Swing Bed Holyoke SWING 61 89 Memorial Hospital, The Craig CAH 66 94 Memorial Hospital, The - Swing Bed Craig SWING 61 89 Middle Park Medical Center Kremmling CAH 66 94 Middle Park Medical Center - Swing Bed Kremmling SWING 61 89 Montrose Memorial Hospital - Rehab Unit Montrose IRF 62 90 Mt. San Rafael Hospital Trinidad CAH 66 94 Mt. San Rafael Hospital - Swing Bed Trinidad SWING 61 89 North Colorado Medical Center - Rehab Unit Greeley IRF 62 90 Northern Colorado Long Term Acute Hospital Johnstown LTCH 63 91 Northern Colorado Rehabilitation Hospital Johnstown IRF 62 90 Pagosa Springs Medical Center Pagosa Springs CAH 66 94 Park Forest Care Center, Inc. Westminster SNFMA 64 92 Parkview Medical Center - Psych Unit Pueblo IPF 65 93 Parkview Medical Center - Rehab Unit Pueblo IRF 62 90 Peak View Behavioral Health Colorado Springs IPF 65 93 Pikes Peak Center Colorado Springs SNFMA 64 92 Pikes Peak Regional Hospital Woodland Park CAH 66 94 Pikes Peak Regional Hospital - Swing Bed Woodland Park SWING 61 89 Pioneers Medical Center Meeker CAH 66 94 Pioneers Medical Center - Swing Bed Meeker SWING 61 89 Poudre Valley Hospital - Psych Unit Ft. Collins IPF 65 93 Prowers Medical Center Lamar CAH 66 94 Revised October 2014 Page 22

Document 04 COLORADO FACILITIES - ALPHABETIC Prowers Medical Center - Swing Bed Lamar SWING 61 89 Rangely District Hospital Rangely CAH 66 94 Rangely District Hospital - Swing Bed Rangley SWING 61 89 Rio Grande Hospital Del Norte CAH 66 94 Rio Grande Hospital - Swing Bed Del Norte SWING 61 89 Rocky Mountain Hospital for Children (Presbyterian-St. Luke's) Denver ACUTE 02 82 San Luis Valley Health - Swing Bed Alamosa SWING 61 89 San Luis Valley Health Conejos County Hospital La Jara CAH 66 94 San Luis Valley Health Conejos County Hospital - Swing Bed La Jara SWING 61 89 Sedgwick County Memorial Hospital Julesburg CAH 66 94 Sedgwick County Memorial Hospital - Swing Bed Julesburg SWING 61 89 Sedgwick County Memorial Nursing Home Julesburg SNFMA 64 92 Select Long Term Care Hospital - Colorado Springs Colorado Springs LTCH 63 91 Select Specialty Hospital - Denver (located at PSL) Denver LTCH 63 91 Select Specialty Hospital - Denver South Campus (located at PAH) Denver LTCH 63 91 Serenity @ Stout Street (residential treatment center) Commerce City OTHER 70 95 Sobriety House, Inc. (residential treatment center) Denver OTHER 70 95 Southeast Colorado Hospital Springfield CAH 66 94 Southeast Colorado Hospital - Swing Bed Springfield SWING 61 89 Southeast Colorado Hospital LTC Center Springfield SNFMA 64 92 Southwest Memorial Hospital Cortez CAH 66 94 Southwest Memorial Hospital- Swing Bed Cortez SWING 61 89 Spalding Rehabilitation Hospital Aurora IRF 62 90 Spanish Peaks Regional Health Center Walsenburg CAH 66 94 Spanish Peaks Regional Health Center - Swing Bed Walsenburg SWING 61 89 Spanish Peaks Veterans Community Living Center Walsenburg SNFMA 64 92 St. Anthony Summit Medical Center - Swing Bed Frisco SWING 61 89 St. Mary's Hospital and Medical Center - Rehab Unit Grand Junction IRF 62 90 St. Vincent General Hospital District Leadville CAH 66 94 Revised October 2014 Page 23

Document 04 COLORADO FACILITIES - ALPHABETIC St. Vincent General Hospital District - Swing Bed Leadville SWING 61 89 Swedish Medical Center - Rehab Unit Englewood IRF 62 90 U.S. Penitentiary and Administrative Maximum Facility Florence LAW 21 87 University of Colorado Cancer Center Denver CA 05 85 University of Colorado Health at Memorial Hospital Central - Children's Hospital Colorado Springs ACUTE 02 82 University of Colorado Health at Memorial Hospital Central - Rehab Unit Colorado Springs IRF 62 90 University of Colorado Hospital Anschutz Inpatient Pavilion - Rehab Unit Denver IRF 62 90 VA Medical Center - Denver Denver FED 43 88 VA Medical Center - Grand Junction Grand Junction FED 43 88 VA Nursing Home - Denver Denver FED 43 88 VA Nursing Home - Pueblo Pueblo FED 43 88 Valley Hope Drug Rehab Center - Denver South (inpatient drug rehabilitation) Centennial OTHER 70 95 Valley Hope Drug Rehab Center - Parker (inpatient drug rehabilitation) Parker OTHER 70 95 Vibra Long Term Acute Care Hospital Thornton LTCH 63 91 Walsh Healthcare Center Walsh SNFMA 64 92 Weisbrod Memorial County Hospital Eads CAH 66 94 Weisbrod Memorial County Hospital Extended Care Unit Eads HOME 01 81 (no Colorado Nursing Home licensure as of this update; considered residential) Weisbrod Memorial County Hospital - Swing Bed Eads SWING 61 89 Wheat Ridge Regional Center - 105th Place Broomfield ICF 04 84 Wheat Ridge Regional Center - 49th House Golden ICF 04 84 Wheat Ridge Regional Center - 53rd Street Denver ICF 04 84 Wheat Ridge Regional Center - 59th House Golden ICF 04 84 Wheat Ridge Regional Center - 67th Group Home Arvada ICF 04 84 Wheat Ridge Regional Center - 68th House Arvada ICF 04 84 Wheat Ridge Regional Center - Depew Denver ICF 04 84 Wheat Ridge Regional Center - Independence Lakewood ICF 04 84 Wheat Ridge Regional Center - Iris House Arvada ICF 04 84 Wheat Ridge Regional Center - Kipling Village Wheat Ridge ICF 04 84 Revised October 2014 Page 24

Document 04 COLORADO FACILITIES - ALPHABETIC Wheat Ridge Regional Center - Lamar Arvada ICF 04 84 Wheat Ridge Regional Center - Nelson Lakewood ICF 04 84 Wheat Ridge Regional Center - Perry Denver ICF 04 84 Wheat Ridge Regional Center - Secrest House Arvada ICF 04 84 Wheat Ridge Regional Center - Xenon Golden ICF 04 84 Wide Horizon Inc. Wheat Ridge SNFPP 04 84 Wray Community District Hospital Wray CAH 66 94 Wray Community District Hospital - Swing Bed Wray SWING 61 89 Yampa Valley Medical Center - Swing Bed Steamboat Springs SWING 61 89 Yuma District Hospital Yuma CAH 66 94 Yuma District Hospital - Swing Bed Yuma SWING 61 89 Legend: Category CA = Designated cancer hospital CAH = Critical Access Hospital CHILD = Medicare certified children's hospital FED = Federal government operated health facility ICF = Intermediate care facility for mentally retarded IPF = Medicare certified inpatient psychiatric facility IRF = Medicare certified inpatient rehabilitation facility LAW = Law enforcement facility LTCH = Medicare certified long term care hospital OTHER = Not defined elsewhere (inpatient drug/alcohol facility) SNFPP = Private pay skilled nursing facility SNFMA = Medicaid-only certified skilled nursing facility SWING = Medicare approved swing bed Revised October 2014 Page 25

Document 04 COLORADO FACILITIES - ALPHABETIC Legend: New codes effective October 1, 2013 The NUBC approved 15 new patient discharge status codes (81-95) adapted from existing codes with "a Planned Acute Care Hospital Inpatient " appended in the title. "" is defined as "An intential readmission after discharge from an acute care hospital that is a scheduled part of the patient's plan of care." These codes apply to the original discharge claim. A readmission is expected according to (and as documented in) the patient s discharge plan. No time frame (between discharge and readmission) is specified in the definition of planned readmission. Effective for discharges from an acute care hospital on or after October 1, 2013. Revised October 2014 Page 26

Document 05 REFERENCES References: 42 CFR 412.4 s and Transfers http://www.gpo.gov/fdsys/pkg/cfr-2011-title42-vol2/pdf/cfr-2011-title42-vol2-sec412-4.pdf Colorado Department of Public Health and Environment - Facility Search https://www.colorado.gov/pacific/cdphe/facility-directory-city-and-county Colorado Reference Sheet for s for Inpatient s with an Effective Date of 7/1/11 (Sue M. Malone, MA, MBA, RHIA, FAHIMA) IPPS Final Rule 2015, FR Vol. 79, No. 163 http://www.gpo.gov/fdsys/pkg/fr-2014-08-22/pdf/2014-18545.pdf IPPS Final Rule 2015, Table 5 (Final Rule and Correction Notice) http://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/fy2015-ipps-final-rule-home-page-items/fy2015-final-rule- Tables.html?DLPage=1&DLSort=0&DLSortDir=ascending New Patient s: Follow-up, AHIMA Codewrite, February 2014 https://newsletters.ahima.org/newsletters/code_write/2014/february/codewrite_codes.html Official UB-04 Data Specifications Manual 2015, Version 9.00, July 2014 (American Hospital Association, National Uniform Billing Committee) www.nubc.org Contacts: Tedi Lojewski, RHIA, CCS, CHDA - Editor, Data Quality Committee Member tlojewski@gmail.com Ann Nowlin, RHIT - CHIMA Office Coordinator anowlin@cox.net Revised October 2014 Page 27