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For the Record
Know nuts & bolts of CMS Condition Codes 42, 43
The Centers for Medicare & Medicaid Services (CMS), of Baltimore, requires Condition Code 42 to be used when a hospital patient is discharged to home health services.
The home health treatment plan is unrelated to the inpatient stay.
However, Condition Code 43 is used when the hospital patient is discharged with home care services that do not begin until after the third day post-discharge.
Providers use both codes with the discharge disposition code 06, which is for patients who are discharged or transferred to home under care of organized home health service organization.