UB04 Admission Source Code D: Transfer from one distinct unit of the hospital to another distinct unit of the same hospital resulting in a separate claim to the payer

Overview

Admission Source Code D is a Point of Origin code used in UB‑04 Field 15 to indicate a transfer from one distinct unit of a hospital to another distinct unit of the same hospital that results in a separate claim to the payer. According to Noridian, the inpatient definition is “admitted as transfer from hospital inpatient within same hospital,” and the outpatient definition is “received outpatient services as transfer from within same hospital.” ^[1]

Code D is part of the national standard code set for admission source / point of origin. It is distinct from Code 4 (transfer from a different facility) and from codes used for transfers from skilled nursing facilities or other health care settings. The UB‑04 claim form, which includes this field, is used by acute inpatient and outpatient hospitals, hospital‑licensed health centers, and other hospital‑based providers, as noted by MassHealth. ^[2]

Because code D signals that a separate claim will be submitted for the receiving unit, it ensures that each distinct hospital unit can bill independently for the services it provided during the patient’s stay. This prevents duplicate billing and clarifies the financial responsibility between units.

When to Use

Use code D only when a patient is transferred between two distinct cost‑center units of the same hospital and each unit generates its own claim. “Distinct unit” means a separately licensed or separately billed department (e.g., medical/surgical unit to intensive care unit, or a general inpatient unit to a psychiatric unit) within the same hospital facility. The transfer must require the hospital to create two separate claims to the payer, one for the initial unit and one for the receiving unit. ^[1]

Code D should not be used for:

• Transfers from another hospital (use Code 4).
• Transfers from a skilled nursing facility (use Code 5).
• Moves within the same unit that do not trigger a new claim.
• Any transfer that does not result in a separate claim.

On the receiving unit’s claim, code D is placed in Field 15 (Point of Origin). The initial unit’s claim (the discharging unit) will typically show the patient’s original admission source (e.g., code 1 for physician referral) rather than code D.

Step-by-Step Claim Example

Scenario: A patient is admitted to Unit A (the medical‑surgical floor) of a hospital. After two days, the patient is transferred to Unit B (the intensive care unit) within the same hospital. The hospital’s billing system treats each unit as a distinct cost center that must submit separate UB‑04 claims.

Claim from Unit A (initial stay):

• Field 15 (Point of Origin) – Enter the original admission source, such as code 1 (physician referral) if the patient came from home.
• All other fields (patient info, dates of service, diagnosis, charges) reflect the care provided in Unit A.

Claim from Unit B (receiving unit):

• Field 15 (Point of Origin) – Enter D (Transfer from one distinct unit of hospital to another distinct unit of same hospital).
• Dates of service begin on the day the patient moved to Unit B.
• Charges are for Unit B’s services only.

Result: The payer receives two separate claims. The claim from Unit B uses code D to indicate that the patient’s point of origin was an inpatient stay within the same hospital. This prevents the payer from expecting a new admission source such as home or another facility. ^[1]

Common Mistakes & Audit Red Flags

• Using code 4 instead of code D – Code 4 (Transfer from a hospital, different facility) is for patients coming from a separate hospital. If a patient transfers between distinct units of the same hospital, code 4 is incorrect and will likely trigger a payer audit or claim denial. ^[1]
• Omitting code D on the receiving unit’s claim – Failing to enter code D may cause the payer to interpret the transfer as a new admission from an unknown source (code 9) or as a continuation of the same stay, leading to duplicate payment or improper bundled payment.
• Using code D when units are not distinct – If the hospital does not bill separately for the two units, code D should not be used. Auditors may flag claims that show code D but are part of a single claim.
• Mismatched dates of service – The receiving unit’s from‑date must match the day after the initial unit’s to‑date. Any gap or overlap can indicate a billing error.
• Inconsistent diagnosis codes – Both claims should share the same primary diagnosis unless the transfer changes the clinical focus. Auditors examine code D claims for diagnosis consistency.

Related Codes/Fields

Code	Meaning (Inpatient/Outpatient)	Source
1	Non‑Health Care Facility Point of Origin (Physician Referral)	[1]
2	Clinic or Physician’s Office	[1]
4	Transfer from a Hospital (different facility)	[1]
5	Transfer from a SNF, ICF, ALF, or NR	[1]
6	Transfer from another Health Care Facility	[1]
8	Court/Law Enforcement	[1]
9	Information Not Available	[1]
D	Transfer from One Distinct Unit of Hospital to Another Distinct Unit of Same Hospital	[1]
E	Transfer from Ambulatory Surgery Center (ASC)	[1]
F	Transfer from Hospice Facility	[1]

Field 15 on the UB‑04 (Point of Origin) accepts these codes. ^[2] notes that the UB-04 is used by inpatient and outpatient hospitals, and these code sets are applicable.

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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