Summary & Overview
HCPCS Level II M1013: Discharge/Discontinuation of Episode of Care
HCPCS Level II code M1013 is used to document the discharge or discontinuation of an episode of care in the medical record. As a clinical-administrative code, it records the formal end of care and supports accurate patient status tracking, care coordination, and downstream administrative actions such as final billing and quality measurement. Nationally, consistent use of M1013 helps standardize documentation around care transitions and episode closure across settings.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise outline of how M1013 is used in clinical documentation, national considerations for payer coverage and claims processing, and operational benchmarks where available. The publication summarizes policy context affecting documentation of episode discontinuation and highlights common billing and coding considerations related to administrative closure of care episodes. It also identifies gaps in available input data where applicable.
The piece is intended for revenue cycle leaders, clinical documentation specialists, and compliance teams seeking a national overview of M1013, with practical context on where the code is applied, which major payers typically recognize it, and what operational topics to review when implementing or auditing documentation workflows for episode closure.
Billing Code Overview
HCPCS Level II code M1013 denotes discharge/discontinuation of the episode of care documented in the medical record. This code represents the documentation event when a clinician or care team records the formal end or discontinuation of an episode of care for a patient.
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Service type: Administrative/clinical documentation of care discontinuation
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Typical site of service: Any clinical setting where episodes of care are managed and documented, including inpatient, outpatient, and ambulatory care settings
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves a clinician documenting the formal discharge or discontinuation of an episode of care in the medical record after completion of a defined course of treatment. For example, a home health nurse completes a home health episode and the supervising clinician documents the discharge summary, including reason for discharge, services provided, patient status at discharge, follow-up plans, and transfer or referral details. This discharge action occurs at the end of an episodic service period (for example, end of home health care, end of a hospice episode, cessation of durable medical equipment rental episode, or completion of a defined plan of care). The clinical workflow includes verification of completion criteria, reconciliation of medications and supplies, patient and caregiver education, documentation of outcomes and remaining needs, signature and date in the medical record, and transmission or filing of the discharge documentation to the ordering provider or care coordinator. Billing staff then assign M1013 to indicate that the episode of care was discontinued or discharged and that the medical record contains the required discharge documentation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required to document discharge is substantially greater than typical (rare for discharge codes). |