UB04 Patient Discharge Status Code 41: Expired in a medical facility

Overview

Patient Discharge Status Code 41, “Expired in a medical facility,” is a UB‑04 field 17 code used when a patient dies while receiving care in a licensed healthcare institution such as a hospital, skilled nursing facility (SNF), intermediate care facility (ICF), or free‑standing hospice ^[1]. This code distinguishes death that occurs within a medical setting from deaths that happen at home (code 40) or at an unknown location (code 42) ^[1].

When to Use

Code 41 must be used when the patient dies inside any medical facility where they were receiving inpatient or outpatient care. The facility types include, but are not limited to, acute care hospitals, critical access hospitals, skilled nursing facilities, intermediate care facilities for individuals with intellectual disabilities, and Medicare‑certified hospice facilities that provide inpatient hospice care ^[1]. If death occurs after the patient has been discharged and taken home, code 40 (“Expired at home”) is appropriate; if the location of death is unknown, code 42 (“Expired – place unknown”) should be reported ^[1]. The code applies to all patient types: inpatient, outpatient, and hospice (when the death occurs in a medical facility rather than at home) ^[1]. For hospice patients, code 51 (“Hospice – medical facility”) is used when the patient is discharged alive; code 41 is used when the patient expires in the hospice facility ^[1].

Step-by-Step Claim Example

A 78‑year‑old patient admitted to General Hospital for pneumonia deteriorates and expires three days later in the intensive care unit. The hospital’s health information management (HIM) team must assign a discharge status code for the UB‑04 claim. Step 1: Confirm the location of death with the attending physician’s documentation – the patient died in the ICU, which is inside the hospital. Step 2: Locate field 17 (“Patient Discharge Status”) on the UB‑04 form (positions 15–16 on the hard‑copy form, but often electronically mapped) ^[2]. Step 3: Enter code “41” in field 17. The meaning is “Expired in a medical facility,” matching the clinical event ^[1]. Step 4: Submit the claim electronically via the Provider Online Service Center (POSC) or through a clearinghouse. MassHealth requires all UB‑04 claims to be submitted electronically unless a waiver has been granted ^[2]. Step 5: After submission, the claim will be processed; remittance advice will show payment for all covered services up to the date of death. No discharge planning or transfer documentation is required because the patient expired. The claim will be closed as a “death” disposition ^[1]. Step 6: For quality reporting (e.g., CMS Outcome Measures), code 41 flags the case for mortality review and may affect facility mortality rates ^[2].

Common Mistakes & Audit Red Flags

A frequent error is using code 20 (“Expired”) instead of code 41. Code 20 is outdated and rejected by many payers, causing claims to be denied or returned for correction ^[1]. Another mistake is reporting code 41 when the patient died at home (code 40) or in an unknown location (code 42). This mismatch can trigger audits because mortality location must match the facility’s medical records ^[1]. For hospice patients, coders sometimes incorrectly use code 51 when the patient expired; code 51 is for discharges alive to a hospice facility, and code 41 is for deaths inside a hospice facility ^[1]. A third red flag is missing or incomplete documentation of the death location. Payers may request the discharge summary or death certificate to verify the code. If the medical record does not explicitly state “died in the hospital” or equivalent, the claim may be placed on medical review ^[2]. Additionally, using code 41 for an outpatient who dies in the emergency department is correct, but some billers erroneously use code 09 (“Admitted as an inpatient”) for patients who die before admission – code 09 should only be used if the patient is admitted as an inpatient and then dies later ^[1]. To avoid these issues, always cross‑reference the UB‑04 code with the clinical documentation and train coding staff on the NUBC definitions.

Related Codes/Fields

The following table lists discharge status codes most closely related to code 41, along with their official meanings as provided by the NUBC and referenced by Noridian.

Code	Meaning	Relationship to Code 41
20	Expired	Historical code; replaced by codes 40‑42. Avoid using on UB‑04. [1]
40	Expired at home	Use when death occurs at patient’s residence. Differentiates home from facility. [1]
42	Expired – place unknown	Use if location of death cannot be determined. [1]
51	Hospice – medical facility	For hospice patients discharged alive to a medical facility. Not for death. [1]
50	Hospice – home	For hospice patients discharged alive to home. Distinguished from death codes. [1]
09	Admitted as an inpatient to this hospital	Used when a patient is admitted; not a discharge status for death. [1]
01	Discharged to home or self-care	Routine discharge alive. Opposite of code 41. [1]

Field 17 is the only UB‑04 field that directly reports discharge status. Secondary fields such as field 18–28 (condition codes) may be used to indicate autopsy or organ donation, but these are separate from the status code. ^[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