UB04 Admission Hour Code 22: 10:00 PM - 10:59 PM

Overview

Admission Hour Code 22 on the UB‑04 claim form represents the time of day a patient was admitted for inpatient care between 10:00 PM and 10:59 PM. This code is part of Form Locator (FL) 13 – Admission/Start of Care Date, which is required on inpatient bills only. According to CMS Transmittal R1915CP, the admission hour is reported using a two‑digit code in military (24‑hour) time, where 00 = 12:00 AM (midnight), 01 = 1:00 AM, and so on up to 23 = 11:00 PM ^[1]. Code 22 specifically denotes that the patient’s admission occurred during the interval from 10:00 PM through 10:59 PM. The hour code is always paired with the admission date entered in FL 13, and both elements together allow payers to verify the chronological point of entry into inpatient care. Therefore, the authoritative source for the meaning and use of code 22 remains the CMS transmittal.

When to Use

Admission Hour Code 22 must be used when the patient’s inpatient admission occurs at any time between 10:00 PM and 10:59 PM, inclusive. For example, if the patient is formally admitted to an inpatient bed at 10:15 PM, the hour code is 22. The same code applies whether the admission is from the emergency department, direct transfer from another facility, or scheduled surgical admission that starts during this hour. Per CMS R1915CP, the code is part of FL 13 and is required only on inpatient bills; outpatient claims do not use an admission hour code on this line ^[1]. If the admission occurs exactly at 11:00 PM, code 23 should be used, not 22, because code 22 covers only the 10:00 PM hour. Always use military time – code 22 is not interchangeable with 10:00 AM (which would be code 10).

Step-by-Step Claim Example

Scenario: A patient is admitted to the hospital for acute chest pain. The physician writes the inpatient admission order at 10:47 PM on May 12, 2024. The patient is placed in a bed at 10:50 PM.

Step 1 – Complete FL 13 – Admission/Start of Care Date. Enter the calendar date of admission: 05/12/2024. According to CMS R1915CP, this field is required on inpatient bills and must contain both the date and the hour code ^[1].

Step 2 – Add the Admission Hour Code. Because the admission occurred during the 10:00 PM hour, enter code 22 in the “Hour” portion of FL 13 (typically a two‑digit box immediately following the date). The complete FL 13 entry would be 05/12/2024 22.

Step 3 – Verify other inpatient fields. Ensure FL 6 (Type of Bill) reflects an inpatient bill (e.g., 111), FL 17 (Patient Status) matches the discharge disposition, and FL 12 (Patient Name) is correct. The MassHealth UB‑04 Guide notes that all required fields must be completed accurately for electronic or paper submission ^[2].

Step 4 – Submit the claim. When the claim is processed, code 22 tells the payer that the admission began during the 22nd hour of the day. This information is used for consistent length‑of‑stay calculation and DRG assignment. No further time notation (such as minutes) is needed on the UB‑04 – only the hour code.

Common Mistakes & Audit Red Flags

• Confusing 10 PM with 10 AM: A frequent error is entering code 10 (10 AM) instead of code 22 for a night‑time admission. CMS R1915CP clearly defines 10 AM as code 10 and 10 PM as code 22 ^[1]. Using code 10 for a 10 PM admission will lead to a mismatch with other time‑sensitive data (e.g., medication administration times) and may prompt payer audits.
• Omitting the hour code entirely: Some billers leave the hour field blank or populate it with zeros. Although a missing hour code may not always result in an immediate rejection, payers often flag claims without an hour code for manual review, especially when the admission date is near midnight. CMS requires the hour code to be present for inpatient bills.
• Rounding or guessing the hour: If the actual admission occurs at 10:55 PM, the correct code is still 22. Do not round to 11:00 PM (code 23) just because it is close. Auditors will verify the time against physician orders and nursing notes. A discrepancy between the claim and clinical documentation can result in a payment adjustment or a denial.
• Using code 22 for an outpatient start of care: FL 13 also serves as the “Start of Care Date” for outpatient services, but the hour code is only applicable to inpatient admissions. Applying code 22 to an outpatient claim is incorrect unless the patient is later admitted. The MassHealth UB‑04 Guide reiterates that FL 13 is “required on inpatient bills only,” reinforcing that the hour code should not be used for outpatient visits ^[2].
• Failing to align with emergency department (ED) arrival time: If the patient arrives in the ED at 9:30 PM but is not admitted until 10:10 PM, the correct hour code is 22 (the admission time), not 21 (9 PM). The admission hour must reflect the moment the inpatient admission order is executed.

Related Codes/Fields

Field/Code	Meaning	Source
FL 13 – Admission Date	Date the patient is admitted for inpatient care	[1]
Code 00	12:00 AM – 12:59 AM (midnight)	[1]
Code 10	10:00 AM – 10:59 AM	[1]
Code 21	9:00 PM – 9:59 PM	[1]
Code 22	10:00 PM – 10:59 PM	[1]
Code 23	11:00 PM – 11:59 PM	[1]
FL 6 – Type of Bill	Indicates inpatient (e.g., 111) vs. outpatient (e.g., 131)	[2]
FL 17 – Patient Status	Required for inpatient claims; e.g., 01 for discharge home	[2]

Note: All hour codes (00–23) follow the same logic as code 22. The complete list is defined in CMS R1915CP ^[1]. The MassHealth UB‑04 Guide provides general billing instructions but does not list hour codes individually; the CMS transmittal is the primary reference for the numeric meanings.

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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