UB04 Admission/Visit Type Code 5: Trauma Center - The patient is admitted to this facility as a trauma center.

Overview

Code 5 in Form Locator 14 (Priority/Type of Admission or Visit) indicates a Trauma Center admission, meaning the patient is admitted to this facility as a trauma center. This code is part of the NUBC-approved coding maintained for the UB-04 form, which serves as a uniform institutional provider bill suitable for multiple third-party payers ^[1]. The UB-04 form, also known as Form CMS-1450, is used by institutional providers to bill Medicare, Medicaid, and other insurers ^[1]. Code 5 specifically identifies that the patient's admission was directly related to trauma center services, distinguishing it from other admission types such as emergency (code 1), urgent (code 2), or elective (code 3) admissions. This code is critical for proper claim processing, as it signals to payers that the facility is designated as a trauma center and the patient received trauma-level care upon admission ^[1]. The code is entered as a single alphanumeric character in FL14, which is a 1-character field ^[1]. Medicare Administrative Contractors (A/B MACs) must be able to capture all NUBC-approved input data for audit trail purposes ^[1].

When to Use

Use Code 5 when the patient is admitted to a facility that is designated as a trauma center, and the admission is directly related to trauma care. This code applies specifically to inpatient admissions where the facility's trauma center designation is the primary reason for the admission ^[1]. It should not be used for emergency department visits that do not result in admission, or for admissions to non-trauma center facilities. The code is appropriate for Level I, II, or III trauma centers as recognized by state or regional trauma systems. When a patient is transferred from another facility specifically for trauma center care, Code 5 should be used to reflect the trauma center admission status ^[1]. Providers must ensure that the facility's trauma center designation is current and recognized by the appropriate authorities. This code is also used when the patient's condition requires immediate trauma team activation and admission to a dedicated trauma service ^[1]. For MassHealth claims, providers must follow the same NUBC coding standards, though MassHealth requires electronic submission for most claims unless an approved exception exists ^[2].

Step-by-Step Claim Example

Scenario: A 45-year-old male is brought by ambulance to a Level I trauma center after a high-speed motor vehicle collision. He is admitted directly to the trauma service with multiple injuries including a fractured femur, rib fractures, and a mild traumatic brain injury.

Step 1: Complete the patient demographic information in FL08 (Patient Name) and FL09 (Patient Address) ^[1].

Step 2: Enter the admission date in FL12 (Admission/Start of Care Date) as a 6-digit numeric field (MMDDYY) ^[1].

Step 3: In FL13 (Admission Hour), enter the two-digit hour of admission using 00-23 military time ^[1].

Step 4: In FL14 (Priority/Type of Admission or Visit), enter 5 to indicate Trauma Center admission ^[1].

Step 5: Complete FL15 (Point of Origin for Admission or Visit) with the appropriate code (e.g., code 4 for transfer from another hospital) ^[1].

Step 6: Enter the Type of Bill in FL04, which should be a 4-digit code starting with the appropriate facility type (e.g., 111 for inpatient hospital) ^[1].

Step 7: Complete all other required fields including FL06 (Statement Covers Period), FL10 (Patient Birthdate), and FL11 (Patient Sex) ^[1].

Step 8: Submit the claim electronically or via paper if an exception has been approved, following MassHealth guidelines ^[2].

Common Mistakes & Audit Red Flags

Common Mistakes:

1. Using Code 5 for emergency department visits that do not result in admission - this code is only for admissions to trauma centers ^[1].
2. Confusing Code 5 with Code 1 (Emergency) - Code 5 is specifically for trauma center admissions, not all emergency admissions ^[1].
3. Using Code 5 for facilities that are not designated trauma centers - this can result in claim denials or audits ^[1].
4. Failing to update the code when a patient's admission type changes (e.g., from trauma center to elective) ^[1].

Audit Red Flags:

1. Inconsistent coding between FL14 (Code 5) and FL15 (Point of Origin) - for example, using Code 5 with a point of origin indicating a routine admission ^[1].
2. Using Code 5 for facilities that do not have a verified trauma center designation ^[1].
3. Repeated use of Code 5 for patients with minor injuries that do not typically require trauma center admission ^[1].
4. Missing or incorrect admission hour (FL13) when using Code 5, as trauma admissions often occur during off-hours ^[1].

Related Codes/Fields

Field/Code	Description	Relationship to Code 5
FL14 Code 1	Emergency	Used for emergency admissions not requiring trauma center designation
FL14 Code 2	Urgent	Used for urgent admissions not requiring trauma center designation
FL14 Code 3	Elective	Used for planned admissions, not trauma-related
FL14 Code 4	Newborn	Used for newborn admissions, not trauma-related
FL15	Point of Origin	Indicates source of admission (e.g., transfer from another hospital)
FL12	Admission Date	Date of trauma center admission
FL13	Admission Hour	Hour of trauma center admission (military time)
FL04	Type of Bill	Facility type and billing period (e.g., 111 for inpatient)
FL17	Patient Discharge Status	Discharge disposition after trauma center care
FL18-28	Condition Codes	Additional conditions related to trauma care

All codes and fields are based on NUBC-approved standards as described in the Medicare Claims Processing Manual ^[1].

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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