UB04 Patient's Relation to Insured Code 40: Cadaver Donor

Overview

Code 40 in UB-04 Form Locator 59 (Patient’s Relation to Insured) is defined as “Cadaver Donor.” This code is part of the standard set of relationship codes used on institutional claims. The Novitas Solutions UB-04 Form Locator list includes code 40 alongside other relationship codes such as 01 (Spouse), 18 (Self), 19 (Child), 20 (Employee), 21 (Unknown), 39 (Organ Donor), 53 (Life Partner), and G8 (Other Relationship). ^[1] The MassHealth UB-04 Billing Guide (February 2021) provides general instructions for completing the UB-04 claim form and references “Code Sets for the UB-04 Claim Form” but does not list individual codes. ^[2] Therefore, the primary source for the meaning of code 40 is the Novitas list. The code is used to indicate that the patient is a cadaver donor, meaning the patient’s body or organs are being donated after death. This relationship code is distinct from code 39 (Organ Donor), which typically applies to living organ donors. The UB-04 form requires a valid relationship code in field 59 to process claims correctly. Without a proper code, claims may be rejected or delayed. The Novitas list serves as a reference for providers to select the appropriate code when the patient is a cadaver donor. ^[1]

When to Use

Use code 40 in UB-04 Field 59 when the patient’s relationship to the insured is that of a cadaver donor. This code applies specifically to deceased individuals whose organs or tissues are being donated for transplantation or research. The insured party is typically the donor’s estate or the organ procurement organization. Code 40 should not be used for living organ donors; for those cases, code 39 (Organ Donor) is appropriate. The Novitas list explicitly separates these two codes, indicating that cadaver donor is a distinct category. ^[1] The MassHealth guide does not provide additional guidance on when to use code 40, but it emphasizes the importance of using correct code sets for claim submission. ^[2] Providers should verify that the patient is deceased and that the donation is posthumous before selecting code 40. This code may be used in conjunction with other fields, such as diagnosis codes or revenue codes related to organ procurement. Because the UB-04 is an institutional claim form, code 40 is typically used by hospitals or transplant centers billing for organ recovery services. The Novitas list is a reliable reference for determining the correct relationship code. ^[1]

Step-by-Step Claim Example

A hospital submits a UB-04 claim for organ recovery services after a deceased patient’s organs are donated. The patient’s name is John Doe, and the insured is the organ procurement organization (OPO). In Field 59 (Patient’s Relation to Insured), the hospital enters code 40 (Cadaver Donor). The Novitas list confirms that code 40 is the correct choice for this scenario. ^[1] The claim also includes the patient’s date of death in Field 56 (Date of Death) and appropriate revenue codes for organ procurement (e.g., 081x). The insured’s name and policy number are entered in Fields 58 and 60. The MassHealth guide notes that all claims must be submitted electronically unless an exemption is granted. ^[2] After completing the form, the hospital submits the claim to the payer. The use of code 40 ensures that the relationship is correctly identified, reducing the risk of claim denial. If code 39 (Organ Donor) were used instead, the claim might be rejected because the patient is deceased. The Novitas list provides the distinction between these codes. ^[1] The claim is processed and paid according to the payer’s policies for cadaveric organ donation.

Common Mistakes & Audit Red Flags

A common mistake is using code 39 (Organ Donor) instead of code 40 for a deceased donor. The Novitas list shows both codes, and using the wrong one can lead to claim rejection or audit flags. ^[1] Another error is leaving Field 59 blank or using an invalid code. The MassHealth guide emphasizes the importance of using correct code sets, but does not list specific codes. ^[2] Auditors may flag claims where code 40 is used but the patient’s date of death is missing or inconsistent. Additionally, if the insured is not clearly identified as the organ procurement organization or estate, the claim may be questioned. Providers should ensure that the patient’s death is documented and that the donation is authorized. Using code 40 for a living donor is a serious error that could result in overpayment or fraud allegations. The Novitas list is the only source provided that defines code 40, so providers should refer to it when training staff. ^[1] Finally, failing to update the claim when the relationship changes (e.g., if the donor is later found to be alive) can cause audit issues.

Related Codes/Fields

Code	Meaning	Source
01	Spouse	[1]
18	Self	[1]
19	Child	[1]
20	Employee	[1]
21	Unknown	[1]
39	Organ Donor	[1]
40	Cadaver Donor	[1]
53	Life Partner	[1]
G8	Other Relationship	[1]

The table above lists all relationship codes provided in the Novitas source. Field 59 on the UB-04 form must contain one of these codes. The MassHealth guide does not provide a similar table. ^[2] Code 40 is specifically for cadaver donors, while code 39 is for living organ donors. Providers should ensure they select the correct code based on the patient’s status at the time of service.

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References

[1] Novitas UB-04 Form Locator — https://www.novitas.com

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