UB04 Admission Source Code 9: Information Not Available

Overview

UB-04 Field 15 (Source of Admission) Code 9, meaning "Information Not Available," is a catch-all code used when the provider cannot determine the patient's point of origin or reason for admission. According to Noridian, this code applies when "reason for admission not known" for inpatients or "where patient came from unknown" for outpatients ^[1]. This code should be used sparingly and only when all other source codes (1–8, D–F) are inapplicable or the information is genuinely unavailable. The MassHealth UB-04 Billing Guide confirms that providers must complete all required fields accurately, and using Code 9 without justification may lead to claim review or denial ^[2]. Code 9 is distinct from codes like 1 (Non-Health Care Facility Point of Origin) or 2 (Clinic/Physician's Office), which require specific knowledge of the patient's origin. Overuse of Code 9 can indicate poor documentation practices, as payers expect providers to capture this information during registration or admission. The code is available for both inpatient and outpatient settings, but its use should be limited to cases where the patient cannot provide the information (e.g., unconscious, confused, or unaccompanied) and no other source is available.

When to Use

Code 9 should be used only when the patient's point of origin or reason for admission is truly unknown and cannot be determined through reasonable efforts. Examples include: an unconscious patient brought in by emergency medical services without identification or accompanying person; a confused elderly patient who cannot recall where they came from; or a patient admitted through the emergency department with no accompanying family or records. It is not appropriate to use Code 9 as a default or when the information is simply difficult to obtain. Noridian explicitly states that Code 9 means "Information Not Available" and should not replace other codes like 1 (home/physician referral) or 4 (hospital transfer) when the information is known ^[1]. For example, if a patient is transferred from a skilled nursing facility but the admitting clerk fails to document it, using Code 9 would be incorrect. Providers should have procedures to capture this information during registration, including checking identification, contacting family, or reviewing ambulance records. MassHealth requires accurate coding to ensure proper payment and avoid audits ^[2]. If the information becomes available later, the claim should be corrected. Code 9 is also not interchangeable with Code 8 (Court/Law Enforcement) or Code D (Transfer from Distinct Unit of Same Hospital), which have specific definitions.

Step-by-Step Claim Example

Scenario: A 72-year-old male is found unconscious on a park bench by emergency medical services (EMS). He has no identification, no family present, and cannot provide any information upon arrival at the hospital. The admitting staff cannot determine where he came from or why he was admitted.

Step 1: Patient Registration – The registration clerk enters the patient's demographic information. Since the patient cannot provide his point of origin and no other source (e.g., police, family, ambulance report) is available, the clerk selects Code 9 (Information Not Available) in Field 15 (Source of Admission).

Step 2: Claim Preparation – The billing staff prepares the UB-04 claim. In Field 15, they enter "9" to indicate the source of admission is unknown. They also complete other required fields: Field 12 (Patient Name), Field 13 (Patient Address), Field 14 (Birth Date), Field 17 (Patient Status), and Field 18–28 (Condition Codes, Value Codes, etc.). The claim is submitted to MassHealth.

Step 3: Payer Processing – MassHealth receives the claim. Because Code 9 is used, the system may flag the claim for review or request additional documentation. The provider must be prepared to justify why the information was unavailable. If the patient later regains consciousness and provides his origin (e.g., home), the provider should submit a corrected claim with Code 1 (Non-Health Care Facility Point of Origin).

Step 4: Documentation – The provider documents in the medical record: "Patient found unconscious, no identification, no accompanying person. Source of admission unknown at time of admission. Code 9 used per Noridian guidelines." This documentation supports the use of Code 9 if audited.

Common Mistakes & Audit Red Flags

Mistake 1: Using Code 9 as a default when information is available. This is the most common error. Providers sometimes use Code 9 to avoid researching the patient's origin, but this can lead to claim denials or audits. Noridian warns that Code 9 should only be used when "reason for admission not known" or "where patient came from unknown" ^[1]. If the patient came from home, use Code 1; if from a clinic, use Code 2.

Mistake 2: Confusing Code 9 with Code 8 (Court/Law Enforcement). Code 8 is for patients admitted upon direction of court or law enforcement, including transfers from incarceration facilities. Using Code 9 when the patient was brought by police but not under court order is incorrect. Code 9 is for unknown origin, not for law enforcement involvement.

Mistake 3: Failing to update the code when information becomes available. If the patient's origin is discovered after admission (e.g., family arrives and states the patient came from home), the claim should be corrected. Leaving Code 9 on the claim when the information is now known is a documentation error.

Audit Red Flags: High frequency of Code 9 usage (e.g., >5% of claims) may trigger payer audits. Payers expect providers to capture this information. MassHealth may request medical records to verify the use of Code 9 ^[2]. Additionally, using Code 9 for elective admissions or scheduled procedures is suspicious, as these patients typically know their origin.

Related Codes/Fields

Code/Field	Description	Relationship to Code 9
Code 1	Non-Health Care Facility Point of Origin (Physician Referral)	Use when patient comes from home, physician's office, or workplace. Code 9 is only for unknown origin.
Code 2	Clinic or Physician's Office	Use when patient is admitted from a clinic or physician's office. Code 9 is not a substitute.
Code 4	Transfer from a Hospital (different facility)	Use for transfers from acute care hospitals. Code 9 is for unknown origin, not transfers.
Code 5	Transfer from SNF, ICF, ALF, or NR	Use for transfers from skilled nursing or assisted living facilities. Code 9 is not appropriate.
Code 6	Transfer from another Health Care Facility	Use for transfers from other health care facilities not defined elsewhere. Code 9 is for unknown origin.
Code 8	Court/Law Enforcement	Use for patients admitted upon court or law enforcement direction. Code 9 is for unknown origin.
Code D	Transfer from Distinct Unit of Same Hospital	Use for transfers within the same hospital. Code 9 is for unknown origin.
Code E	Transfer from Ambulatory Surgery Center (ASC)	Use for transfers from ASCs. Code 9 is for unknown origin.
Code F	Transfer from Hospice Facility	Use for transfers from hospice. Code 9 is for unknown origin.
Field 12	Patient Name	Required field; must match patient identification.
Field 17	Patient Status	Indicates discharge status; related to admission source for continuity of care.

All codes and descriptions are from ^[1] and ^[2].

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References

[1] Noridian Point of Origin — https://med.noridianmedicare.com/web/jea/topics/claim-submission/point-of-origin-codes

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