UB04 Admission Source Code E: Transfer from Ambulatory Surgery Center

Overview

Code E in the UB-04 Admission Source field (Field 15) indicates a Transfer from Ambulatory Surgery Center (ASC). This code is used when a patient is admitted to a hospital inpatient unit or presents for outpatient services directly from an ambulatory surgery center. The source text from Noridian specifies: "E: Transfer from Ambulatory Surgery Center (ASC) - Inpatient: admitted as transfer from ASC. Outpatient: came for outpatient services from ASC." [Noridian Point of Origin](https://med.noridianmedicare. ^[1]

When to Use

Code E should be used in two primary scenarios. First, when a patient is admitted as an inpatient to a hospital directly from an ambulatory surgery center—for example, if a patient undergoes a procedure at an ASC but develops complications requiring hospital admission. Second, when a patient presents for outpatient hospital services (such as diagnostic testing, observation, or additional procedures) after being referred from an ASC. The Noridian source explicitly states: "E: Transfer from Ambulatory Surgery Center (ASC) - Inpatient: admitted as transfer from ASC. Outpatient: came for outpatient services from ASC." ^[2] It is important to note that this code is not appropriate for patients coming from a physician's office (use Code 1 or 2), from a hospital (use Code 4 or D), or from a skilled nursing facility (use Code 5). The code specifically applies when the originating facility is a licensed ambulatory surgery center, which is defined as a facility that provides outpatient surgical services but does not provide overnight inpatient care. During the procedure, the patient experiences a cardiac arrhythmia requiring monitoring. The ASC staff call 911 and transfer the patient to the local hospital for inpatient admission.

Step 1: Complete the patient demographic information in Fields 1-13 of the UB-04 form, including patient name, address, and insurance information.

Step 2: In Field 15 (Source of Admission), enter code "E" to indicate the patient was transferred from an ambulatory surgery center. The Noridian source confirms: "E: Transfer from Ambulatory Surgery Center (ASC) - Inpatient: admitted as transfer from ASC." ^[2]

Step 3: Complete Field 14 (Type of Admission/Visit) with the appropriate code (e.g., "1" for emergency if the transfer was urgent, or "4" for elective if the admission was planned).

Step 4: In Field 17 (Patient Discharge Status), enter the appropriate code (e.g., "01" for discharged to home, or "02" for discharged/transferred to another facility).

Step 5: Complete Fields 18-50 with service dates, revenue codes, procedure codes, diagnosis codes, and charges. For this example, the primary diagnosis would be the cardiac arrhythmia (e.g., I48.91), and the procedure would be the knee arthroscopy (e.g., 29881).

Step 6: Submit the claim electronically or on paper (if waiver approved) following MassHealth guidelines. The MassHealth guide notes: "Effective January 1, 2012, MassHealth adopted an all-electronic claims submission policy to achieve greater efficiency. All claims must be submitted electronically, unless the provider has received an approved electronic claim submission waiver." ^[1]

Common Mistakes & Audit Red Flags

Mistake 1: Using Code E for patients from physician offices or clinics. Code E is specifically for transfers from ambulatory surgery centers, not from physician offices (Code 1 or 2) or clinics. The Noridian source clearly distinguishes: "1: Non-Health Care Facility Point of Origin (Physician Referral) - Includes patients coming from home, physician's office, or workplace." ^[2]

Mistake 2: Using Code E for patients transferred from hospital outpatient departments. If a patient comes from a hospital outpatient department (not an ASC), use Code 4 (Transfer from a Hospital) or Code D (Transfer from One Distinct Unit of Hospital to Another). The Noridian source states: "4: Transfer from a Hospital (different facility) - Inpatient: admitted as hospital transfer from acute care facility." ^[2]

Mistake 3: Failing to document the ASC transfer in medical records. Auditors will look for documentation confirming the patient was physically at an ASC immediately prior to the hospital encounter. Without supporting documentation, claims using Code E may be denied or flagged for review.

Audit Red Flag: Claims using Code E for outpatient services when the patient was actually referred from a physician's office rather than an ASC. This can trigger medical necessity reviews and potential recoupment. Providers should ensure that the ASC is a licensed facility and that the transfer is clearly documented in the patient's medical record.

Related Codes/Fields

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

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References

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

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