UB04 Admission Hour Code 10: 10:00 AM - 10:59 AM

Overview

Code 10 in Field 13 (Admission Hour) of the UB-04 claim form represents the time period 10:00 AM through 10:59 AM. This code is part of a 24-hour military time system where codes range from 00 (12:00 AM/midnight) through 23 (11:00 PM). ^[1]

Field 13 captures the admission/start of care date and the corresponding hour of admission. The admission hour code must be entered as a two-digit number (00-23) that represents the hour when the patient was admitted for inpatient care or when outpatient care began. ^[1]

For code 10, this means the admission occurred during the 10:00 AM hour. This code is required on inpatient bills only, though it may also appear on outpatient claims when start of care time is documented. ^[1]

MassHealth requires all claims to be submitted electronically unless the provider has received an approved electronic claim submission waiver. The UB-04 paper form instructions still apply for those with approved exceptions. ^[2]

When to Use

Use code 10 when the patient's admission or start of care occurred between 10:00 AM and 10:59 AM on the date entered in Field 13. This applies to inpatient admissions where the exact hour of admission is required for billing and utilization review purposes. ^[1]

The code is mandatory for inpatient hospital claims. For outpatient services, the admission hour may be required when the start of care time affects billing, such as for observation services or same-day surgery that began during this hour. ^[1]

Providers should use code 10 when the patient's admission time falls anywhere within the 10:00 AM hour, regardless of the exact minute. For example, an admission at 10:15 AM, 10:30 AM, or 10:45 AM all use code 10. ^[1]

MassHealth providers must ensure the admission hour code matches the time documented in the patient's medical record. The code should reflect the actual time of admission, not the time the order was written or when the patient arrived at the nursing unit. ^[2]

Step-by-Step Claim Example

Scenario: A patient is admitted to the hospital on March 15, 2024 at 10:23 AM for chest pain observation.

Step 1: Locate Field 13 on the UB-04 form. This field requires both the admission date and the admission hour code. ^[1]

Step 2: Enter the admission date in the date portion of Field 13. For this example, enter 03/15/2024 (MM/DD/YYYY format). ^[1]

Step 3: Determine the correct admission hour code. Since the admission occurred at 10:23 AM, which falls within the 10:00 AM hour, use code 10. ^[1]

Step 4: Enter code 10 in the admission hour field of Field 13. The completed field should show: 03/15/2024 with admission hour code 10. ^[1]

Step 5: Verify the code matches the medical record documentation. The nursing admission assessment or physician order should confirm the 10:23 AM admission time. ^[2]

Step 6: Submit the claim electronically through MassHealth's approved electronic claims system, unless the provider has an approved waiver for paper submission. ^[2]

Common Mistakes & Audit Red Flags

Mistake 1: Using AM/PM format instead of military time. Code 10 represents 10:00 AM, not 10:00 PM. Providers sometimes confuse this with code 22 (10:00 PM). Always use the 24-hour clock system. ^[1]

Mistake 2: Rounding to the nearest hour incorrectly. If admission occurred at 10:59 AM, use code 10. Do not round up to code 11 (11:00 AM). The code represents the hour in which admission occurred, not the nearest hour. ^[1]

Mistake 3: Using code 10 for outpatient services when not required. While code 10 is required for inpatient admissions, some payers may not require admission hour for outpatient services. Check payer-specific requirements before including the code. ^[1]

Audit Red Flag: Discrepancies between the admission hour code and the medical record documentation. Auditors will compare the code to nursing notes, physician orders, and registration timestamps. A mismatch may trigger a claim review or denial. ^[2]

Audit Red Flag: Using code 10 for admissions that occurred during a different hour. For example, if the patient was admitted at 9:45 AM but the claim shows code 10, this may indicate a data entry error or intentional misrepresentation. ^[1]

Audit Red Flag: Missing admission hour code entirely on inpatient claims. Some payers may reject claims that omit the admission hour code. Always verify the field is completed for inpatient admissions. ^[1]

Related Codes/Fields

Code/Field	Description	Relationship to Code 10
Field 13	Admission/Start of Care Date	Contains the admission date and hour code; code 10 is entered here
Code 00	12:00 AM - 12:59 AM	Midnight hour; opposite end of the 24-hour cycle from code 10
Code 11	11:00 AM - 11:59 AM	Next hour after code 10; used for admissions at 11:00 AM or later
Code 09	9:00 AM - 9:59 AM	Previous hour before code 10; used for admissions at 9:00 AM
Code 22	10:00 PM - 10:59 PM	Evening equivalent of code 10; commonly confused with code 10
Field 14	Priority of Admission	Indicates type of admission (emergency, urgent, elective)
Field 15	Point of Origin	Shows where patient came from (home, transfer, etc.)
Field 16	Discharge Hour	Uses same 24-hour code system as admission hour

^{[1] [2]}

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References

[1] CMS R1915CP — https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1915CP.pdf

[2] MassHealth UB-04 Guide — https://www.mass.gov/doc/ub-04-billing-guide-0/download