UB04 Field 14: Admission/Visit Type

Overview

Field 14 (Box 14) on the UB-04 claim form captures the Priority (Type) of Admission or Visit, a single alphanumeric character that indicates the urgency or type of encounter. This field is required for both inpatient and outpatient claims according to Medicare and MassHealth guidelines. ^[1] specifies that Form Locator 14 is a 1-character alphanumeric field with a buffer space of 2. ^[2] confirms this field is mandatory for all claim types. The National Uniform Billing Committee (NUBC) maintains the approved code set for this field, which Medicare Administrative Contractors (A/B MACs) also use for processing institutional claims. ^[1] notes that instructions for completion are the same for inpatient and outpatient claims unless otherwise noted Poisson.

When to Use

Field 14 must be completed on every UB-04 claim, whether inpatient or outpatient. ^[1] states this field is required for all claim types submitted on Form CMS-1450. For inpatient admissions, the code reflects the priority of admission (e.g., emergency, urgent, elective, newborn). For outpatient visits, the code indicates the type of visit (e.g., emergency department, clinic visit, observation). ^[2] requires this field for all MassHealth claims, including those submitted via Direct Data Entry on the POSC. The field is used by payers to determine medical necessity, coverage rules, and reimbursement methodologies. For example, emergency admissions (code 1) may have different prior authorization requirements than elective admissions (code 4). ^[1] emphasizes that the A/B MAC must capture all NUBC-approved input data for audit trail purposes.

Step-by-Step Claim Example

Scenario: A 65-year-old Medicare patient presents to the emergency department with chest pain and is admitted as an inpatient.

Step 1: Determine the admission type. The patient was admitted through the emergency department with a life-threatening condition → use code 1 (Emergency).

Step 2: Locate Box 14 on the UB-04 form. This is a single-character field located between Box 13 (Admission Hour) and Box 15 (Point of Origin). ^[1] shows FL14 as "Priority (Type) of Admission or Visit" with size 1 AN and buffer space 2.

Step 3: Enter the code 1 in Box 14. Do not add leading zeros or spaces.

Step 4: Complete related fields: Box 12 (Admission Date), Box 13 (Admission Hour), Box 15 (Point of Origin – use code 1 for emergency department), and Box 17 (Patient Discharge Status).

Step 5: Verify the claim. The Type of Bill (Box 4) should be 0110 (inpatient hospital) or 0111 (inpatient hospital – claim includes outpatient services). ^[2] requires all fields to be completed accurately for claim processing.

Result: The completed claim shows code 1 in Box 14, indicating an emergency admission, which supports the medical necessity of the inpatient stay.

Common Mistakes & Audit Red Flags

Mistake 1: Using code 1 (Emergency) for scheduled elective surgeries. This is a major audit red flag. ^[1] requires accurate coding of admission priority. Using emergency codes for non-emergent admissions can trigger medical necessity reviews and potential recoupment.

Mistake 2: Leaving Box 14 blank. This field is required for all claims. ^[2] mandates completion of this field. A blank field may cause claim rejection or return for correction.

Mistake 3: Using code 9 (Information not available) when the admission type is clearly documented. This code should only be used when the admission priority is truly unknown. Overuse of code 9 may indicate poor documentation practices.

Mistake 4: Inconsistent coding between Box 14 and Box 15 (Point of Origin). For example, using code 1 (Emergency) in Box 14 but code 4 (Transfer from a skilled nursing facility) in Box 15 may create a logical inconsistency. ^[1] requires all fields to be completed accurately for audit trail purposes.

Mistake 5: Using outdated or non-NUBC-approved codes. Only codes maintained by the National Uniform Billing Committee should be used. ^[1] states that Medicare Administrative Contractors maintain lists of codes used by Medicare.

Related Codes/Fields

Field	Box Number	Description	Relationship to Box 14
Admission Date	12	Date of admission/start of care (MMDDYY)	Must be consistent with admission priority
Admission Hour	13	Hour of admission (00-23)	Supports the admission type (e.g., emergency admissions often occur after hours)
Point of Origin	15	Source of admission/visit (e.g., emergency department, transfer)	Should logically align with Box 14 code
Patient Discharge Status	17	Discharge disposition code	Completes the admission-to-discharge episode
Type of Bill	4	Bill type (e.g., 0110 for inpatient)	Determines whether Box 14 applies to inpatient or outpatient
Condition Codes	18-28	Additional conditions affecting payment	May provide context for admission priority
Occurrence Codes/Dates	31-34	Specific events with dates	Can support the admission type (e.g., accident date for emergency)

^[1] and ^[2]

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References

[1] CMS Chapter 25 — https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c25.pdf

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