# New to Home Health Care Coding



## RMAHAN89 (Jun 23, 2016)

Any Home Health Care Coders out there?
I just started a position 3 months ago with a trainer who has 14 yrs in the business. She has to step back and let me take over and I still have a lot of struggles especially with sequencing codes. I'm also receiving a book soon from Decision Health on Home Health Care Coding scenarios. I use as many resources online, and from the coding books I have but sometimes it just isn't the same as having the experience. Every day I'm  doing practice scenarios with cases from the company. 
Any other suggestions for a brand new coder?
Is this a common struggle new coders have in the business? Don't know if i should take a step back maybe do an extern-ship or get certified in Home Health Care Coding. The CPC exam did not prepare me for this specific field and the complexity of sequencing an average of 20 codes on a patient.

Thanks

Rachael Mahan CPC-A
ramahan@amazingcare.com


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## LLBS29XX (Jul 12, 2016)

*New Home Health Coder*

I feel your grief! I have been doing this for six months and my problem is also sequencing. Just when I think I have it right then the nurse staff changes the codes on me. It is a whole new ball game and actually Medicare states that the Clinician should be assigning the primary and secondary diagnosis. We are not suppose to make that decision. The oasis I have read and re-read and since most is fill in the blanks, not much narrative it is hard. My facility is also not allowed to query the physicians when it is not clear and there lies the problem with unspecified codes. "I do not assume". And they say their reimbursement is going down. Wait until January. I also have grief with aftercare for surgeries, TKA and how to code the accurately. I have the Decision Health "Home Care Coding Specialist-Diagnosis (HCS-D) ICD-10 CM Certification Study Guide" It helps a lot with coding for home health and the guidelines. Also Decision Health as a GREAT forum that you can join and ask questions and it is all geared to home health. AAPC does not offer a certification nor did the CPC course cover anything other than physician 485's. I am thinking about getting my certification with Decision Heath. If you have any questions I might be able to help with I will be happy to try to answers them but the experts are on the Decision Health List manager.


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## RMAHAN89 (Jul 14, 2016)

*New Home Health Care Coder*



LLBS29XX said:


> I feel your grief! I have been doing this for six months and my problem is also sequencing. Just when I think I have it right then the nurse staff changes the codes on me. It is a whole new ball game and actually Medicare states that the Clinician should be assigning the primary and secondary diagnosis. We are not suppose to make that decision. The oasis I have read and re-read and since most is fill in the blanks, not much narrative it is hard. My facility is also not allowed to query the physicians when it is not clear and there lies the problem with unspecified codes. "I do not assume". And they say their reimbursement is going down. Wait until January. I also have grief with aftercare for surgeries, TKA and how to code the accurately. I have the Decision Health "Home Care Coding Specialist-Diagnosis (HCS-D) ICD-10 CM Certification Study Guide" It helps a lot with coding for home health and the guidelines. Also Decision Health as a GREAT forum that you can join and ask questions and it is all geared to home health. AAPC does not offer a certification nor did the CPC course cover anything other than physician 485's. I am thinking about getting my certification with Decision Heath. If you have any questions I might be able to help with I will be happy to try to answers them but the experts are on the Decision Health List manager.



Thank you for your response. It is so encouraging to find out I'm not alone. Luckily my boss has ordered the Decision Health Scenario book for me. But I am interested in purchasing that study guide you mentioned as well. Now there is another outside resource that the company is letting me use. She is great and looks over my coding to go through the accuracy. Have you noticed how different each coder codes? It seems a common trait I've noticed! I want to be accurate enough to not get MCR denials but I am not going to be an exact replica of the coders I'm learning from. Everyone codes just a little different. We use allscripts and they require that a primary has to be in the chart before an initial visit can be made. ARgghh. so frustrating.
The clinicians here are not allowed to touch the codes until talking to me our my supervisors but I don't have the medical background to have as much knowledge about the diseases, etc. There are a few nurses here that help me out a lot which is awesome. Man that sounds so hard that you can't query the provider either. I am not allowed since I'm technically not qualified but the case supervisors or intake coordinators do. I just wish there was one more coder that was equal or had a little more experience than me so we could work together. Right now there is my trainer who has 14 years experience coding but she does QA and management and doesn't ever really have time to help me and I think she's so far above me it's hard to understand her. And then there is the contracted coder that used to work at this co. that fills in for me when I'm sick. She is really helpful i send her each cases and she audits it. But her coding is soooooo different from my trainer so it's hard to be somewhere in the middle, they can't both be right?.Right?
Thank you for offering your help. I'll take you up on that for sure

Rachael


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## JMarieBrandt (Aug 4, 2016)

There isn't much Home Health Coding guidance out there. Its limited to the guidance given in the Decision Health Manual, the HCS-D study guide, and any webinars/coding forums you can find. 

But the information provided at the beginning of each chapter of the Decision Health Manual is jam-packed full of information. Each time a new manual comes out, I sit and read each section, and make notes in my book. 

The study guide offers a lot of guidance also. You can also find a lot of guidance online, and Coding Clinic guidance as well. 

I read somewhere that someone is having an issue with clinicians making changes to their codes once they are assigned... I literally felt my blood pressure rise. You need to get with your management/supervisor. No changes should be made to codes without a discussion being had with coding first. If they disagree, it needs to be a conversation... not them making changes. I feel like whats the point in hiring coders if agencies are going to tell clinicians to do whatever they want with the codes anyway? ...just certify them in coding and let them code their own charts. I understand that the OASIS belongs to them, but as a professional courtesy, and for accuracy, all changes should go through coding prior to an OASIS being locked. Clinicians are not coders, and typically have a really hard time removing the clinical aspect of it and coding just the black and white. 

I've gone to several Home Health coding summits. Judy Adams hosts a lot of them on the East Coast. She is one of the authors of the Decision Health Coding Manual. You may want to google any that are in your area. And your agency will likely pay for your attendance. 

As far as the Decision Health listserv, be cautious... a lot of contributors of that forum are new to coding, and a lot of others are issuing incorrect coding advice. If you receive advise from there, ask them to cite their source... you need to be able to see the guidance in black and white. If you get audited, you cant say "so and so from the Decision Health forum said to do it this way." Not trying to be funny.... but really.


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