Awareness : OBC Tips

Acute Hospital Readmissions without Condition Code B4 or 42

An improper payment occurs when two separate acute hospital claims are paid for a Medicare patient who is discharged and re-admitted on the same day and for the same Diagnosis Related Group (DRG) and there is no B4 or 42 Condition Code (CC) on the second claim.

These condition codes would indicate the following:

  • B4 - Admission Unrelated to Discharge - Admission unrelated to discharge on same day.
  • 42 - Continued care not related to inpatient admission - Continuing care plan is not related to the condition or diagnosis for which the individual received inpatient hospital services.