UB04 Patient Discharge Status Code 85: Discharged/transferred to a designated cancer center or children's hospital with a planned acute care hospital readmission

Overview

Code 85 signifies “Discharged/transferred to a designated cancer center or children’s hospital with a planned acute care hospital inpatient readmission.” It became effective October 1, 2013, and is part of the National Uniform Billing Committee (NUBC) patient discharge status code set. ^[1]

The code is one of several “planned readmission” variants added in 2013 to distinguish cases where the discharge/transfer to a specific facility type is accompanied by a pre-arranged acute care hospital readmission. The base code for the same facility type without a planned readmission is code 05 (“Discharged/transferred to a designated cancer center or children’s hospital”). ^[1]

Providers use code 85 when the patient is moved to a facility that has been formally designated as a cancer center (e.g., NCI‑designated comprehensive cancer center) or a children’s hospital, and the clinical plan explicitly includes a return to an acute care hospital for an inpatient stay that is scheduled at the time of discharge. The “planned readmission” element distinguishes this code from code 05, which implies no such scheduled return. ^[1]

When to Use

Use code 85 only when both of the following conditions are met:

1. The patient is discharged/transferred to a designated cancer center (e.g., an NCI‑designated comprehensive cancer center) or a children’s hospital that meets the Centers for Medicare & Medicaid Services (CMS) definition of a children’s hospital.
2. There is a planned acute care hospital inpatient readmission at the time of discharge. This readmission must be documented in the patient’s medical record and be part of the care plan (e.g., to complete a surgical procedure after initial medical management at the cancer center). ^[1]

Do not use code 85 if the patient is going to a general acute care hospital, a skilled nursing facility, or any other facility type that is not a designated cancer center or children’s hospital. For transfers to a short‑term general hospital with a planned readmission, use code 82. For transfers to a cancer center or children’s hospital without a planned readmission, use code 05. ^[1]

The code is effective for discharges on or after October 1, 2013. ^[1]

Step-by-Step Claim Example

Scenario: A 10‑year‑old patient with a complex congenital heart defect is initially admitted to an acute care hospital. After stabilization, the patient is transferred to a designated children’s hospital for specialized cardiac monitoring. The care plan includes a planned readmission to the original acute care hospital in two weeks for surgical repair.

Step 1 – Determine the appropriate discharge status code: Because the transfer is to a children’s hospital and a planned acute care hospital inpatient readmission is documented, code 85 applies. ^[1]

Step 2 – Complete the UB‑04 form:

• In the patient discharge status field (typically Form Locator 17, per standard UB‑04 layout used by payers including MassHealth as described in the MassHealth UB‑04 Billing Guide), enter 85.
• Enter the admitting diagnosis, principal diagnosis, and other required data as usual. The UB‑04 claim form is used by acute inpatient hospitals when submitting paper claims to MassHealth. ^[2]

Step 3 – Document the planned readmission: Ensure the medical record contains a clear note of the planned acute care readmission, including date or time frame and reason. This documentation supports the use of code 85 during an audit.

Step 4 – Submit the claim: The completed UB‑04 is sent to the payer (e.g., MassHealth). For MassHealth, electronic submission is mandatory unless a waiver is granted. ^[2]

Using code 85 correctly ensures the transfer is recognized as part of a coordinated care plan and may affect payment and quality reporting (e.g., readmission measures). ^[1]

Common Mistakes & Audit Red Flags

• Using code 05 instead of 85: Code 05 (“Discharged/transferred to a designated cancer center or children’s hospital”) is for transfers without a planned acute care readmission. If a readmission is scheduled, code 85 must be used. Using 05 incorrectly may suggest the readmission was unplanned, potentially affecting reimbursement or quality metrics. ^[1]

• Using code 85 for a non-designated facility: The receiving facility must be a formally designated cancer center or children’s hospital. Transfer to a general hospital with a cancer unit does not qualify. Auditors will check facility designation.

• No documentation of planned readmission: The medical record must contain explicit documentation (e.g., a discharge order stating “transfer to Children’s Hospital with planned readmission on [date]”). Lack of documentation is a red flag.

• Mixing codes for the same episode: If the patient is transferred to a cancer center without a planned readmission but later is readmitted as an emergency, code 05 is correct for the initial discharge. Using 85 in that case is a miscoding.

• Effective date errors: Code 85 is only valid for discharges on or after October 1, 2013. Claims with earlier discharge dates should use older code sets. ^[1]

Related Codes/Fields

Code	Meaning (from Noridian Patient Status)	Relation to Code 85
05	Discharged/transferred to a designated cancer center or children's hospital (no planned readmission)	Base code without planned readmission; use 85 when readmission is planned.
81	Discharged/transferred to home/self-care with planned acute care readmission	Same planned‑readmission concept but to home
82	Discharged/transferred to short‑term general hospital with planned readmission	Same concept but to a general hospital
83	Discharged/transferred to SNF (Medicare certified) with planned readmission	Same concept but to SNF
84	Discharged/transferred to custodial/supportive care facility with planned readmission	Same concept but to custodial care
86	Discharged/transferred to home health with planned readmission	Same concept but to home care
87	Discharged/transferred to court/law enforcement with planned readmission	Same concept but to law enforcement
88	Discharged/transferred to federal health care facility with planned readmission	Same concept but to federal facility
89	Discharged/transferred to swing bed with planned readmission	Same concept but to swing bed
90	Discharged/transferred to IRF with planned readmission	Same concept but to rehab facility
91	Discharged/transferred to LTCH with planned readmission	Same concept but to long‑term care hospital
92	Discharged/transferred to Medicaid‑only nursing facility with planned readmission	Same concept but to non‑Medicare nursing
93	Discharged/transferred to psychiatric hospital/unit with planned readmission	Same concept but to psychiatric facility
94	Discharged/transferred to CAH with planned readmission	Same concept but to critical access hospital

All codes above are effective October 1, 2013. ^[1]

Related UB-04 field: Patient discharge status is typically reported in Form Locator 17 on the UB‑04 claim form, as referenced in the MassHealth UB‑04 Billing Guide. ^[2]

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References

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

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