UB04 Patient Discharge Status Code 88: Discharged/transferred to a federal health care facility with a planned acute care hospital readmission

Overview

Patient discharge status code 88 is defined as “Discharged/transferred to a federal health care facility with a planned acute care hospital inpatient readmission (effective 10/1/13).” ^[1] This code is part of the set of “planned readmission” codes added on October 1, 2013, which are used when the patient’s discharge or transfer is to a specific type of facility and there is a known, scheduled acute care hospital readmission. Code 88 differs from code 43 (“Discharged/transferred to a federal health care facility”) because code 43 does not include a planned readmission component. ^[1] The MassHealth UB-04 Billing Guide references the use of standard code sets for the claim form, confirming that such codes apply to MassHealth claims. ^[2] Proper use of code 88 ensures accurate billing, appropriate payment, and correct tracking of readmissions for quality measurement.

When to Use

Code 88 should be used when a patient is discharged or transferred from an acute care hospital to a federal health care facility and there is a documented, planned acute care hospital inpatient readmission. ^[1] The code is effective from October 1, 2013. The documentation in the medical record must clearly indicate the planned nature of the readmission. If no planned readmission exists, use code 43 (federal health care facility without planned readmission). Using code 88 appropriately helps avoid overpayment or audit penalties and aligns with Medicare’s readmission reduction program tracking. ^[1]

Step-by-Step Claim Example

Consider a 65-year-old Medicare beneficiary admitted to a general acute care hospital for pneumonia. During the stay, it is determined the patient requires transfer to a Veterans Affairs (VA) hospital for ongoing care. Additionally, the patient is scheduled to return to the acute care hospital in three weeks for a planned joint replacement surgery. Upon discharge to the VA facility, the hospital must report code 88 in the patient discharge status field on the UB-04 claim.

Step 1: Complete all other required UB-04 fields per MassHealth billing instructions. The MassHealth UB-04 Guide requires submission of paper claims only with an approved waiver; otherwise electronic submission is mandatory. ^[2]

Step 2: In Form Locator 17 (Patient Discharge Status), enter “88”. Per Noridian, code 88 means “Discharged/transferred to a federal health care facility with a planned acute care hospital inpatient readmission.” ^[1]

Step 3: In Form Locator 6 (Patient Name) and other demographic fields, enter standard information. In Form Locator 21 (Diagnosis Codes), list relevant ICD-10 codes.

Step 4: In Form Locator 66–67 (Diagnosis and Procedure Codes), include the planned readmission details if applicable.

Step 5: Submit the claim electronically (or on paper if a waiver is on file). MassHealth requires all claims to be submitted electronically unless the provider has an approved waiver. ^[2]

Using code 88 ensures the payer recognizes the discharge as a transfer to a federal facility with a planned readmission, which affects payment adjustments and readmission tracking.

Common Mistakes & Audit Red Flags

Common errors in using code 88 include:

• Using code 43 instead of 88: When a planned acute care readmission exists, code 88 must be used; code 43 is for transfers without a planned readmission. ^[1]
• Using code 88 for non‑federal facilities: Code 88 is only for federal health care facilities. Applying it to a non‑federal facility (e.g., a skilled nursing facility) is incorrect. Instead, use the appropriate code such as 83 (SNF with planned readmission). ^[1]
• Missing documentation of the planned readmission: The medical record must contain a clear plan for the acute care readmission. Without it, auditors may deny the code and recoup payments.
• Using code 88 retroactively or when readmission is unplanned: The planned readmission must be known at discharge. Using code 88 for an unplanned future admission is a red flag.
• Inconsistent coding between claim and medical record: If the patient status code on the claim does not match clinical notes, it triggers audit review.

Providers should train staff to distinguish between code 88 and code 43, and to document planned readmissions explicitly. The effective date of October 1, 2013 should be noted; use of earlier codes after that date is incorrect. ^[1]

Related Codes/Fields

The table below lists related patient discharge status codes for federal health care facilities and other facilities with planned readmissions, as well as the relevant UB-04 field. All codes are effective October 1, 2013 unless noted. Source: ^[1]

Code	Description	UB-04 Field
43	Discharged/transferred to a federal health care facility (no planned readmission)	Form Locator 17
88	Discharged/transferred to a federal health care facility with a planned acute care hospital inpatient readmission	Form Locator 17
81	Discharged to home or self-care with a planned acute care hospital inpatient readmission	Form Locator 17
82	Discharged/transferred to a short-term general hospital for inpatient care with a planned acute care hospital inpatient readmission	Form Locator 17
83	Discharged/transferred to a skilled nursing facility (SNF) with Medicare certification with a planned acute care hospital inpatient readmission	Form Locator 17
84	Discharged/transferred to a facility that provides custodial or supportive care with a planned acute care hospital inpatient readmission	Form Locator 17
85	Discharged/transferred to a designated cancer center or children’s hospital with a planned acute care hospital inpatient readmission	Form Locator 17
86	Discharged/transferred to home under care of organized home health service organization with a planned acute care hospital inpatient readmission	Form Locator 17
87	Discharged/transferred to court/law enforcement with a planned acute care hospital inpatient readmission	Form Locator 17
89	Discharged/transferred to a hospital-based Medicare approved swing bed with a planned acute care hospital inpatient readmission	Form Locator 17
90	Discharged/transferred to an inpatient rehabilitation facility (IRF) with a planned acute care hospital inpatient readmission	Form Locator 17
91	Discharged/transferred to a Medicare certified long term care hospital (LTCH) with a planned acute care hospital inpatient readmission	Form Locator 17
92	Discharged/transferred to a nursing facility certified under Medicaid but not under Medicare with a planned acute care hospital inpatient readmission	Form Locator 17
93	Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit with a planned acute care hospital inpatient readmission	Form Locator 17
94	Discharged/transferred to a critical access hospital (CAH) with a planned acute care hospital inpatient readmission	Form Locator 17

The UB-04 Form Locator 17 (Patient Discharge Status) is the dedicated field for all these codes. The MassHealth UB-04 Guide confirms that code sets are used for claim completion. ^[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