UB04 Condition Codes Code 40: Same Day Transfer

Overview

Condition Code 40, meaning "Same Day Transfer," is used on the UB-04 claim form to indicate that a patient was discharged from one inpatient facility and admitted to another inpatient facility on the same calendar day. ^[1] The code is part of the standard condition codes set maintained by the Centers for Medicare & Medicaid Services (CMS) and is recognized by both Medicare and Medicaid payers, including MassHealth. ^[2]

Proper use of Code 40 ensures accurate claims processing, especially for Medicare Severity Diagnosis Related Group (MS-DRG) payments, as same-day transfers may trigger per-diem payment adjustments rather than the full DRG payment. ^[1] Providers must report this code in the Condition Code field (Form Locator 18-28) on the UB-04 claim form. Both the transferring facility and the receiving facility have specific billing requirements for same-day transfer scenarios. The code must be entered exactly as "40" with no leading or trailing spaces.

When to Use

Code 40 should be used when a patient is discharged from an acute care hospital, critical access hospital, or other inpatient setting and admitted to another inpatient facility (such as another hospital, skilled nursing facility, or inpatient rehabilitation unit) on the same calendar day. ^[1] This includes transfers initiated by the patient's physician for specialized care, transfers between partnered facilities, or transfers when the original facility cannot provide the required level of care. The code applies regardless of whether the transfer was planned or unplanned.

Do not use Code 40 for patient discharges to home, even if the patient later re-presents to another facility that same day, as this constitutes a separate admission rather than a transfer. Similarly, if the patient is discharged but dies before reaching another facility, this is not a same-day transfer. The code also does not apply to outpatient transfers or emergency department visits that result in direct admission to the same hospital. For partial outpatient hospitalization services, use Code 41 instead of Code 40. ^[1]

Step-by-Step Claim Example

Scenario: A 72-year-old patient is admitted to Hospital A for acute respiratory failure. After 3 days, the patient is stable but requires skilled nursing care. At 10:00 AM on day 4, the patient is discharged from Hospital A and admitted to Sunnyvale Skilled Nursing Facility at 11:30 AM the same day. Both providers bill for the episode.

Step 1: Determine the need for Code 40. The patient was discharged from an acute inpatient setting and admitted to a skilled nursing facility on the same calendar day. This qualifies as a same-day transfer. ^[1]

Step 2: Complete Hospital A's UB-04 claim. In Form Locators 18-28 (Condition Codes), enter "40" in the first available position. Ensure no other condition codes on the claim contradict the same-day transfer (e.g., do not use Code 44 "Inpatient admission changed to outpatient" simultaneously). The bill type should be 111 (inpatient hospital) with statement covers period from day 1 to day 4. ^[2]

Step 3: Complete Sunnyvale SNF's UB-04 claim. The receiving facility should use Code 40 in their condition codes as well, indicating the patient was admitted as a transfer. Their bill type may be 211 or 213 depending on the SNF's Medicare certification status. The statement covers period starts on the same date as the transfer.

Step 4: Submit both claims separately. MassHealth requires electronic submission unless the provider has an approved waiver. ^[2] Both claims reference the same patient and same transfer date. Hospital A's claim will typically receive a per-diem payment, while Sunnyvale SNF's claim may receive the full DRG-based payment for the remaining SNF stay.

Common Mistakes & Audit Red Flags

Mistake 1: Using Code 40 for non-same-day transfers. If the patient is discharged at 11:59 PM and admitted at 12:01 AM the next day, this is not a same-day transfer. Using Code 40 in such cases can trigger claim denials or recoupments. ^[1]

Mistake 2: Failing to include Code 40 on the transferring facility's claim. The transferring hospital must include Code 40; otherwise, Medicare may pay the full DRG amount and later recoup the overpayment during an audit. Both transferring and receiving facilities should report the code.

Mistake 3: Confusing Code 40 with other transfer codes. Code 40 is specific to same-day inpatient-to-inpatient transfers. Do not use it for outpatient transfers (Code 41), SNF readmissions (Code 57), or emergency department transfers.

Audit Red Flag: Missing documentation of transfer. The medical record must clearly document the transfer order, time, and destination facility. Auditors frequently review condition code justifications during post-payment reviews. If the documentation does not support the same-day transfer, the claim may be denied.

Audit Red Flag: Inconsistent dates between facilities. If the transferring facility's discharge date differs from the receiving facility's admission date, the claims may be flagged for review. Verify dates are exact matches.

Related Codes/Fields

Code/Field	Description	Relationship to Code 40
Code 41	Partial outpatient hospitalization services	Use instead of Code 40 for outpatient partial hospitalization transfers
Code 44	Inpatient admission changed to outpatient	Distinguish from same-day transfers when an admission is converted
Code 57	SNF readmission within 30 days	Use for SNF-to-SNF or SNF-to-hospital transfers within 30 days
Form Locator 12	Patient Name	Must match across transferring and receiving facility claims
Form Locator 15	Patient Address	Include for accurate claim matching
Form Locator 17	Patient Discharge Status Code	Use code 02 (discharged/transferred to another short-term general hospital) or 03 (discharged/transferred to SNF) as appropriate
Form Locator 42	Revenue Codes	Typically 0100-0199 for inpatient services; revenue codes should reflect actual services provided
Form Locator 46	Service Units	Reflects number of days in each revenue center; partial day transfers require day-level billing
Form Locator 66	Diagnosis Codes	Primary and secondary diagnoses must be consistent across both facilities' claims
Bill Type (Form Locator 4)	Type of Bill	Use 111 for acute inpatient hospital; 211 or 213 for SNF; third digit indicates sequence (1 = through bill, 2 = interim, etc.)

^{[1] [2]}

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References

[1] Noridian Condition Codes — https://med.noridianmedicare.com/web/jea/topics/claim-submission/condition-codes

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