UB04 Patient Discharge Status Code 40: Expired at home

Overview

Patient discharge status code 40 is defined as “Expired at home” on the UB‑04 claim form. ^[1] This code is part of the standard set of patient discharge status codes used by hospitals and other institutional providers to indicate the patient’s disposition at the time of discharge. ^[1] The Noridian list includes code 40 among the valid discharge statuses effective for Medicare and many other payers. ^[1]

When to Use

Code 40 is used when a patient expires at home, meaning the location of death is the patient’s personal residence. ^[1] Providers must ensure that the patient’s medical record clearly documents that the death occurred at home, and that no other discharge disposition (e.g., to a skilled nursing facility or hospice) applies. ^[2] (The MassHealth guide does not detail code 40 specifically but references the use of standard code sets on the UB‑04.) ^[2] Code 40 is not appropriate for patients who die in the hospital (use code 20) or in another medical facility (use code 41). ^[1]

Step-by-Step Claim Example

A hospital submits a UB‑04 claim for a patient who was admitted for palliative care and discharged to home hospice. Two days after discharge, the patient expires at home. The hospital must report the discharge status in field 17 using code 40 “Expired at home.” ^[1] The MassHealth UB‑04 guide illustrates that field 17 is used for the patient discharge status code and is a required field on the form. ^[2] The claim would also include the patient’s demographic information, dates of service, revenue codes, and other charges. ^[2] The hospital should verify that the medical record contains documentation of the home death, such as a death certificate or a note from the hospice provider. ^[2] No other discharge status code (e.g., 01 for home/self-care) should be entered because the patient did not survive the discharge period. ^[1] The claim is then submitted electronically unless the provider has an approved paper waiver. ^[2]

Common Mistakes & Audit Red Flags

A frequent error is using code 20 “Expired” when the patient died at home, or vice versa. ^[1] Code 20 is for death occurring in the hospital; code 40 is for death at home. ^[1] Another mistake is selecting code 41 “Expired in a medical facility” when the patient died at home. ^[1] Auditors will look for consistency between the discharge status code and other claim fields, such as the type of bill or revenue codes indicating hospice services. ^[2] Using code 40 without supporting documentation (e.g., a death certificate, hospice note, or ambulance report confirming location of death) is a red flag and can lead to claim denial or recoupment. ^[2] Providers should also ensure that code 40 is not applied to patients who were discharged alive and later died at home; if the death occurred after the inpatient stay ended, the discharge status at the time of discharge remains the original disposition (e.g., code 01). ^[1] (The Noridian list does not address post-discharge death, but code 40 is listed alongside other discharge statuses, implying its use at the time of discharge.)

Related Codes/Fields

The following table shows codes related to code 40 from the Noridian patient discharge status list, along with the UB‑04 field where the status is entered.

Code	Meaning	Source
20	Expired	[1]
40	Expired at home	[1]
41	Expired in a medical facility (e.g., hospital, SNF, ICF, or free-standing hospice)	[1]
42	Expired - place unknown	[1]
UB‑04 Field 17	Patient Discharge Status	[2]

These codes are mutually exclusive; only one discharge status should be reported per claim. ^[1] The MassHealth UB‑04 guide confirms that field 17 is part of the standard form layout and must be completed with a valid code from the national code set. ^[2]

---

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