UB04 Patient Discharge Status Code 69: Discharged/transferred to a designated disaster alternative care site

Overview

Patient Discharge Status Code 69 indicates that a patient was discharged or transferred to a designated disaster alternative care site. This code became effective for use on UB-04 claim forms on October 1, 2013, as published in Medicare patient status code lists ^[1]. The code is part of a comprehensive set of discharge status codes that describe the destination or condition of a patient after they leave an inpatient facility. These codes are critical for accurate billing and claims processing, as they inform payers about the type of facility or care setting the patient moved to. Code 69 specifically addresses scenarios during emergency preparedness situations, such as natural disasters or public health emergencies, where patients are relocated to temporary care sites established by health authorities. It is distinct from other transfer codes because it applies only to locations officially designated as disaster alternative care sites, not to standard healthcare facilities like hospitals or skilled nursing facilities. The MassHealth UB-04 Billing Guide acknowledges a standard code set for claim forms, but does not specifically list code 69, so the primary authoritative source for this code is the Medicare patient status listing ^[2]. Understanding code 69 helps providers select the correct discharge status when reporting transfers to alternative care arrangements during federally or state-declared disasters.

When to Use

Code 69 should be used only when a patient is discharged or transferred from an inpatient setting to a site that has been formally designated as a disaster alternative care site by an appropriate authority, such as a state health department or the Federal Emergency Management Agency (FEMA). According to the Noridian patient status list, this code covers discharges or transfers to such facilities, effective October 1, 2013 ^[1]. It is not appropriate for patients who are moved to a standard hospital, skilled nursing facility, rehabilitation unit, or any other permanent healthcare institution; those transfers require different codes (e.g., code 02 for a short-term general hospital). Disaster alternative care sites are typically temporary structures or repurposed buildings used during emergencies when the usual healthcare infrastructure is overwhelmed or damaged. Common examples include field hospitals set up after hurricanes, mobile medical units deployed during pandemics, or convention centers converted into patient care areas. The code also applies if a patient is transferred from one disaster alternative care site to another, as long as the initial discharge is from an inpatient hospital. Providers must verify that the receiving site is indeed designated as an alternative care site by a recognized emergency management agency. Using code 69 incorrectly, such as for a transfer to a non-designated temporary shelter, could lead to claim denials, because payers expect the site to meet the official definition. The MassHealth guide emphasizes the importance of using correct code sets, so providers should cross-reference code 69 with any applicable state or plan-specific guidelines ^[2]. In summary, code 69 is reserved for specific disaster-related transfers that are not covered by any other patient discharge status code.

Step-by-Step Claim Example

Consider a patient admitted to a general acute care hospital after a severe earthquake. The hospital sustains damage and must evacuate all inpatients. The state health department has established a disaster alternative care site at a local sports arena, designated as such under an emergency declaration. The patient is stable enough for transfer and is moved to this arena site. In this scenario:

1. On the UB-04 claim form, the provider enters “69” in the patient discharge status field (located in the “Patient Discharge Status” section of the form). This code precisely describes the transfer to a designated disaster alternative care site, as listed in the Medicare patient status code set ^[1].

2. The date of discharge and transfer should reflect the actual date the patient left the hospital. No separate admission code is needed for the alternative site because it is not a permanent healthcare facility.

3. Supporting documentation, such as internal records of the evacuation order and confirmation that the arena was officially designated as a disaster alternative care site, should be retained by the provider. Payers may request this documentation to validate use of code 69.

4. The claim is submitted using standard UB-04 instructions. As noted in the MassHealth guide, all claims must be submitted electronically unless a waiver is approved, but the code set remains the same ^[2].

5. If the patient later requires readmission from the alternative site to a hospital, a different patient status code (e.g., code 09 for admitted as an inpatient to this hospital) would be used on the subsequent claim.

This example illustrates the correct application of code 69 in a genuine disaster scenario, ensuring compliance with payer requirements for transfer to an alternative care site.

Common Mistakes & Audit Red Flags

One common mistake is using code 69 when a patient is transferred to a facility that is not officially designated as a disaster alternative care site, such as a regular shelter or a non-healthcare building used for temporary housing. The code definition explicitly requires the site to be “designated” as a disaster alternative care site; relying on informal arrangements can lead to claim rejection or audit findings ^[1]. Another error is using code 69 for transfers to skilled nursing facilities or other Medicare-certified institutions, which should use codes like 03, 64, or 65 instead. Payers often cross‑check the receiving facility type against state emergency plans, so mismatches raise red flags.

Auditors may also flag claims with code 69 if the discharge date predates the effective date of October 1, 2013, as the code was not valid before that date. Inconsistent documentation, such as missing evidence of the disaster declaration or the facility’s designation, invites scrutiny. Additionally, using code 69 for a patient who actually left against medical advice (code 07) or expired (code 20) is a serious misrepresentation. Providers should ensure that the transfer is to a temporary care site and not to a long‑term or acute‑care hospital (which would require code 02 or 66). The MassHealth billing guide stresses that accurate code sets are essential for proper payment, so any deviation from the intended use of code 69 will require justification ^[2]. To avoid these pitfalls, staff should confirm the designation status with emergency management officials before assigning code 69, and maintain detailed records of the disaster circumstances.

Related Codes/Fields

The table below lists selected patient discharge status codes from the same source as code 69, showing their meanings and effective dates. These codes are used in the same UB-04 field (field 17) and help clarify when code 69 is appropriate versus other transfer scenarios.

Code	Meaning	Effective Date (if applicable)
01	Discharged to home or self-care (routine discharge)	Always
02	Discharged/transferred to a short-term general hospital for inpatient care	Always
03	Discharged/transferred to skilled nursing facility (SNF) with Medicare certification	Always
04	Discharged/transferred to a facility that provides custodial or supportive care	Always
20	Expired	Always
61	Discharged/transferred to a hospital-based Medicare approved swing bed	Always
62	Discharged/transferred to an inpatient rehabilitation facility (IRF)	Always
66	Discharged/transferred to a critical access hospital (CAH)	Always
69	Discharged/transferred to a designated disaster alternative care site	10/1/13
70	Discharged/transferred to another type of health care institution not defined elsewhere	Always
81	Discharged to home or self-care with a planned acute care hospital inpatient readmission	10/1/13
82	Discharged/transferred to a short-term general hospital for inpatient care with planned readmission	10/1/13

All codes above are sourced from the Noridian patient discharge status list ^[1]. Code 69 uniquely addresses disaster-related transfers, while other codes cover routine and planned readmission scenarios. The UB-04 field for patient discharge status is standard, and the MassHealth guide confirms that providers must follow the official code sets when completing claims ^[2].

---

References

[1] Noridian — https://med.noridianmedicare.com/web/jea/topics/claim-submission/patient-discharge-status-codes

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