UB04 Admission/Visit Type Code 9: Information Not Available - The facility is unable to determine the type of admission.

Overview

Form Locator 14 (FL14) on the UB-04 claim form captures the Priority (Type) of Admission or Visit. This one-character alphanumeric code indicates the urgency or circumstance under which a patient was admitted or seen. The National Uniform Billing Committee (NUBC) maintains the approved code set for this field, and Medicare Administrative Contractors (A/B MACs) also maintain lists of codes used by Medicare. ^[1] specifies that FL14 is a required data element for institutional claims, and the internal claim record used for processing must capture all NUBC-approved input data for audit trail purposes. The MassHealth UB-04 Billing Guide confirms that MassHealth follows NUBC code sets for completing the UB-04 claim form. ^[2]

Code 9 is one of the NUBC-approved values for FL14. Its meaning is “Information Not Available – The facility is unable to determine the type of admission.” This code is used when the provider cannot ascertain whether the admission was emergency, urgent, elective, newborn, or any other defined category. It serves as a default or fallback when documentation or patient history does not support a more specific code.

When to Use

Code 9 should be used only when the facility genuinely cannot determine the type of admission or visit. This may occur in situations where the patient is unable to provide a reliable history, records from a transferring facility are missing, or the admission circumstances are ambiguous. For example, an unconscious patient brought in without identification or collateral information might warrant code 9 if no other source can clarify the admission type. However, providers should make every reasonable effort to assign a more specific code (e.g., 1 for Emergency, 2 for Urgent, 3 for Elective) because payers often use FL14 for utilization review, payment determination, and quality measurement. ^[1] notes that Medicare does not need to obtain data that is not needed to process the claim, but the A/B MAC must be able to capture all NUBC-approved input data. Therefore, using code 9 may trigger additional scrutiny or requests for documentation. MassHealth also expects accurate coding to ensure proper claim processing and coordination of benefits. ^[2]

Step-by-Step Claim Example

Consider a patient brought to the emergency department by ambulance after a car accident. The patient is unconscious, has no identification, and no family member is present. The hospital admits the patient to an inpatient unit but cannot determine whether the admission was an emergency (because the patient was already in the ED) or an elective (clearly not). The medical record lacks any documentation of the admission type.

1. Complete FL14 with code 9 (Information Not Available).
2. Complete other required fields: FL12 (Admission/Start of Care Date) with the date of admission, FL13 (Admission Hour) with the hour, FL15 (Point of Origin) with the appropriate code (e.g., 1 for Non-Health Care Facility Point of Origin), and FL17 (Patient Discharge Status) when applicable.
3. Submit the claim to the appropriate payer. For Medicare, the provider sends the Form CMS-1450 (UB-04) to its A/B MAC. For MassHealth, the claim must be submitted electronically unless an approved waiver exists. ^[2]
4. Retain documentation explaining why code 9 was used, in case the payer requests justification. The provider keeps the “Institution Copy” of the UB-04. ^[1]

If later the patient’s identity is confirmed and the admission type becomes known, the provider should submit a corrected claim with the appropriate code.

Common Mistakes & Audit Red Flags

• Overuse of code 9: Using code 9 as a default when a more specific code is available. Payers may flag claims with code 9 for medical review because it suggests incomplete documentation.
• Inconsistent coding: Using code 9 in FL14 but indicating an emergency point of origin (e.g., code 1 in FL15) without justification. This inconsistency can lead to claim denials or requests for additional information.
• Failure to update: Not correcting the code when the admission type later becomes known. Medicare and MassHealth expect accurate data; a corrected claim should be submitted.
• Missing documentation: Not retaining evidence of why code 9 was used. The A/B MAC may request supporting records. ^[1] states that the provider must be able to pass coordination of benefits data and maintain an audit trail.
• Ignoring payer-specific rules: Some payers may not accept code 9 or may require a specific alternative. Providers should verify payer guidelines. MassHealth’s billing guide emphasizes following NUBC codes, but individual payers may have additional requirements. ^[2]

Related Codes/Fields

The table below lists other common FL14 codes and related fields on the UB-04 that interact with the admission type.

Code / Field	Description	Source
FL14 Code 1	Emergency – The patient required immediate medical intervention.	NUBC (referenced in [1])
FL14 Code 2	Urgent – The patient required care within 24 hours.	NUBC
FL14 Code 3	Elective – The patient’s condition permitted time to schedule admission.	NUBC
FL14 Code 4	Newborn – Admission of a newborn infant.	NUBC
FL14 Code 5	Trauma Center – Admission via a trauma center activation.	NUBC
FL14 Code 9	Information Not Available – Facility unable to determine type.	NUBC
FL12	Admission/Start of Care Date – Must be consistent with the admission type.	[1]
FL15	Point of Origin for Admission or Visit – Indicates the source of the patient (e.g., home, clinic, transfer).	[1]
FL17	Patient Discharge Status – Used in conjunction with admission type for utilization review.	[1]

Note: The NUBC code set is the authoritative source for FL14 values. Medicare and MassHealth adopt these codes. ^[1] and ^[2] provide general instructions for completing the form.

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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