UB04 Patient Discharge Status Code 20: Expired

Overview

Patient Discharge Status Code 20 indicates that the patient expired while in the facility (e.g., hospital, inpatient unit). This code is used on the UB-04 claim form in Field 17 (Patient Discharge Status) to report the patient’s disposition at the time of discharge. According to the Noridian patient status list, Code 20 is defined simply as “Expired.” ^[1]

The UB-04 claim form is the standard paper claim used by institutional providers (e.g., hospitals, skilled nursing facilities) to bill Medicare, Medicaid, and other payers. MassHealth’s UB-04 billing guide explains that “the following providers must use the UB-04 claim form when submitting paper claims to MassHealth: acute inpatient hospitals, acute outpatient hospitals, including hospital-licensed health centers and other hospital sat” (sentence truncated in source). While the MassHealth guide does not provide a specific entry for Code 20, it confirms that discharge status codes are required for completing the claim form. ^[2]

Code 20 is distinct from other expiration codes such as 40 (expired at home) or 41 (expired in a medical facility after discharge). It applies only when the death occurs during the current stay and the patient is formally discharged as deceased. Accurate use of this code is critical for billing, quality reporting, and mortality statistics.

When to Use

Use Patient Discharge Status Code 20 when the patient dies while admitted to your facility and is discharged as deceased. This includes deaths that occur in the hospital, in a hospital-based outpatient department if the patient was an inpatient (check payer rules), or in any inpatient setting where the patient expires before a planned transfer or discharge. The Noridian list shows Code 20 as a standalone entry: “20: Expired.” It does not require any additional modifier or planned readmission indicator. ^[1]

Do not use Code 20 for patients who die after being discharged home (use Code 40) or who die in another medical facility after transfer (use Code 41). Also, do not use Code 20 for patients who are still alive at the time of discharge and later expire; the discharge status reflects the patient’s condition at the exact moment of discharge. If the patient was dead on arrival (DOA) and never admitted, a different reporting method applies (typically no inpatient claim). For inpatient claims, Code 20 should be used only when the patient expired during the covered stay. The MassHealth UB-04 guide emphasizes that all claims must be submitted electronically unless a waiver is granted, but the same discharge status rules apply. ^[2]

Step-by-Step Claim Example

Scenario: A 78-year-old patient is admitted to an acute inpatient hospital on March 1 for pneumonia. Despite treatment, the patient expires on March 3 at 11:45 PM. The physician pronounces death, and the patient is discharged as deceased.

Steps:

1. Complete Field 17 (Patient Discharge Status): Enter “20” from the Noridian code list. This tells the payer the patient expired during the stay. ^[1]

2. Complete Field 14 (Admission Date): Enter 03/01/2025.

3. Complete Field 16 (Discharge Hour): Enter the hour (e.g., 23 for 11:00 PM) and corresponding minute in the time fields. The UB-04 instructions (per MassHealth guide) require the discharge hour. ^[2]

4. Complete Field 15 (Source of Admission): Use appropriate code (e.g., physician referral, emergency room). Not directly related to Code 20 but required.

5. Complete Field 66 (Attending Provider ID) and other provider fields. Ensure the attending physician certifies the death.

6. Complete remaining claim fields (patient demographics, charges, covering payer). The MassHealth guide notes that providers must follow “detailed instructions for completing the paper UB-04 claim form for MassHealth claims.” ^[2]

7. Submit the claim either electronically (as required by MassHealth unless waiver obtained) or on paper with an approved waiver. Use Code 20 to indicate the discharge status.

Result: The payer processes the claim with the expired status, which may affect payment (e.g., per diem rates might be adjusted) and triggers required death reporting.

Common Mistakes & Audit Red Flags

• Using Code 20 for deaths after discharge: If the patient is discharged alive and later dies at home, use Code 40 (expired at home) or Code 41 (expired in medical facility). Using Code 20 in that scenario misrepresents the discharge status and may lead to audit findings. Noridian’s list explicitly separates Code 20 from 40 and 41. ^[1]

• Confusing Code 20 with Code 42 (Expired – place unknown): Code 42 is used when the death location is known but not the exact place (e.g., body found). Only use Code 20 if death occurred in the facility.

• Missing discharge hour or incomplete time fields: The MassHealth UB-04 guide requires accurate discharge hour reporting. Omitting the hour can cause claim rejection. ^[2]

• Using Code 20 for outpatient deaths: If a patient dies in the emergency department before admission, the claim is typically an outpatient claim and the discharge status (Field 17) may be left blank or use a different code. Check payer-specific instructions.

• Not updating claim if death occurs after claim submission: If the patient was initially billed as discharged alive but later died (e.g., during the same stay), a corrected claim with Code 20 must be submitted. Auditors compare discharge status against medical records.

• Failing to report death to legal authorities: While not a billing error, failure to comply with state reporting can trigger additional scrutiny of the claim.

Related Codes/Fields (markdown table)

The following table lists related patient discharge status codes from the Noridian source that are commonly associated with expiration or death. All codes below are from ^[1].

Code	Meaning	When to Use Instead of 20
20	Expired	Use when patient dies during the current inpatient stay.
40	Expired at home	Use if patient was discharged alive and later found dead at home.
41	Expired in a medical facility (e.g., hospital, SNF, ICF, or free-standing hospice)	Use if patient died after transfer to another medical facility.
42	Expired – place unknown	Use when death location is unknown (e.g., body found).

Additional fields on the UB-04 that interact with discharge status include:

Field Number	Field Name	Relevance to Code 20
14	Admission Date	Required to compute length of stay. Must match date of admission.
16	Discharge Hour	Required to record time of death (per MassHealth guide).
17	Patient Discharge Status	Field where Code 20 is entered.
66	Attending Provider ID	Must match provider who certified death.

These fields and codes ensure accurate reporting of patient death and compliance with payer requirements.

---

References

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

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