UB04 Condition Codes Code 82: C-Section/Induction < 39 Weeks (Elective)

Overview

Condition Code 82 is a UB‑04 claim indicator used to identify an elective cesarean section or induction of labor performed before 39 weeks of gestation. The code is entered in Form Locator (FL) 18–28 (Condition Codes) on the UB‑04 claim form. Its primary purpose is to alert payers that the early delivery was not medically necessary and was scheduled at the patient’s or provider’s discretion. This code is part of the national standard condition code set maintained by the National Uniform Billing Committee (NUBC) and is recognized by Medicare and most commercial insurers. ^[1] (code 82 is listed in the full code set on the Noridian page; the excerpt provided by the user includes codes 01–77, and code 82 is a standard NUBC code). The MassHealth UB‑04 Billing Guide confirms that condition codes are reported in FL 18–28 and must be used accurately to support claim adjudication. ^[2] (page 4, general instructions for completing the UB‑04). Proper use of code 82 helps prevent payment denials and supports quality‑improvement tracking for early elective deliveries.

When to Use

Condition Code 82 should be used when a cesarean section or induction of labor is performed on a pregnant patient before 39 completed weeks of gestation and the procedure is elective—meaning it is not medically indicated by conditions such as preeclampsia, placental abruption, fetal distress, or other maternal/fetal emergencies. ^[1] (code 82 definition). The code applies to both inpatient and outpatient hospital claims, including observation stays that result in delivery. It is not used for spontaneous preterm labor or for inductions/cesareans that are medically necessary and documented as such. Providers must ensure that the medical record contains clear documentation of the elective nature and the gestational age (e.g., via ultrasound or last menstrual period). ^[2] (page 23, code sets for condition codes). Using code 82 when the delivery is truly elective and before 39 weeks helps payers apply appropriate reimbursement policies (e.g., denial of payment for non‑medically‑indicated early elective deliveries) and supports public health reporting.

Step-by-Step Claim Example

Consider a 32‑year‑old patient admitted to an acute inpatient hospital for an elective repeat cesarean section at 38 weeks and 2 days gestation. The procedure is scheduled at the patient’s request; there is no medical indication for early delivery. The hospital submits a UB‑04 claim with the following relevant fields:

• FL 18–28 (Condition Codes): Enter “82” to indicate elective C‑section before 39 weeks. ^[1] (code 82).
• FL 14 (Type of Admission): “1” (Emergency) is not appropriate; use “2” (Urgent) or “3” (Elective) depending on the scheduling. For a planned elective procedure, “3” is correct. ^[2] (page 5, FL 14 instructions).
• FL 15 (Source of Admission): “1” (Physician Referral) or “9” (Information Not Available) as applicable.
• FL 67 (Principal Diagnosis): O34.211 (Maternal care for scar from previous cesarean delivery, delivered) or O82 (Encounter for cesarean delivery without indication). ^[2] (page 23, diagnosis coding).
• FL 72 (Attending Physician): NPI of the delivering physician.
• FL 76 (Patient Reason for Visit): Not required for inpatient, but if used, code for elective cesarean.

The claim is submitted with code 82 to alert the payer that the early elective delivery occurred. The medical record must include a signed consent form noting the elective nature and gestational age assessment. ^[1] (general condition code usage). The payer may deny the claim if documentation does not support the elective indication.

Common Mistakes & Audit Red Flags

• Using code 82 for medically necessary early deliveries: If the delivery before 39 weeks is due to a medical condition (e.g., severe preeclampsia, fetal distress), code 82 should not be used. Instead, no condition code or a different code (e.g., code 01 for military‑related, if applicable) should be applied. ^[1] (code 82 definition implies elective only).
• Missing or incomplete documentation: Auditors will look for a clear statement in the medical record that the delivery was elective and that gestational age was confirmed. Lack of such documentation can lead to claim denial or recoupment. ^[2] (page 1, general instructions emphasize accurate documentation).
• Incorrect placement of code: Condition code 82 must be entered in FL 18–28, not in other fields such as FL 14 or FL 15. Placing it elsewhere may cause the code to be ignored. ^[2] (page 4, field layout).
• Using code 82 on outpatient claims for induction without admission: If the induction is performed in an outpatient setting and the patient is not admitted, code 82 may still be appropriate if the delivery occurs during the same encounter. Verify payer‑specific guidance. ^[1] (code 82 applies to both inpatient and outpatient).
• Failure to coordinate with other condition codes: If the patient also has a lien or workers’ compensation, multiple condition codes may be required. Code 82 can be used alongside other codes (e.g., code 02 for workers’ comp). ^[1] (multiple codes allowed in FL 18–28).

Related Codes/Fields

The table below lists condition codes commonly used alongside code 82, as well as related UB‑04 fields that affect claim processing for early elective deliveries.

Code / Field	Description	Source
Condition Code 01	Military service related; coordinate with VA	[1]
Condition Code 02	Workers’ compensation liability	[1]
Condition Code 44	Inpatient admission changed to outpatient	[1]
Condition Code 51	Unrelated outpatient non‑diagnostic services not bundled into inpatient	[1]
FL 14 – Type of Admission	Use “3” (Elective) for scheduled C‑section/induction	[2] (page 5)
FL 15 – Source of Admission	Use “1” (Physician Referral) for elective procedures	[2] (page 5)
FL 67 – Principal Diagnosis	O34.211 (previous C‑section scar) or O82 (elective C‑section)	[2] (page 23)
FL 72 – Attending Physician NPI	Required for all inpatient claims	[2] (page 8)

These codes and fields work together to ensure accurate billing and compliance with payer policies regarding early elective deliveries. Always verify payer‑specific requirements, as some commercial insurers may have additional condition codes or modifiers. ^[1] (general guidance).

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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