Home Health & Hospice Week

Essential:  Expand your options for reporting encephalopathies.

Don't let new coding updates throw off your case mix scores.

Most notable: New and changed codes effective Oct.1 will allow you to be more specific when reporting encephalopathies.

Caveat: There's no grace period for adjusting to the new codes, so it pays to take the time now to prepare.

Break Out Myelitis Diagnosis

Be sure your coders are current on these crucial updates:

Thirteen new codes and many revisions in the 323.x (Encephalitis, myelitis, and encephalomyelitis) category mean additions to the list of codes that can bring you additional case mix points.

Previously, codes in this category lumped together encephalitis, myelitis, and encephalomyelitis. The new codes break out myelitis diagnoses, notes Lisa Selman-Holman, consultant and principal of Selman-Holman & Associates in Denton, TX. The result is 13 new case mix codes that will be spread among the primary list of case mix codes and the manifestation list of case mix codes, she says.

For example: The code description for 323.0 (Encephalitis in viral diseases classified elsewhere) will be revised to read (Encephalitis, myelitis, and encephalomyelitis in viral diseases classified elsewhere). The new codes in this subcategory separate the myelitis from the encephalopathies: 323.01 (Encephalitis and encephalomyelitis in viral diseases classified elsewhere) and 323.02 (Myelitis in viral diseases classified elsewhere).

Bonus: Reporting each of the 13 new case mix codes will add 20 neuro points when reported, says Selman-Holman.

Time for new cheat sheets: Your case mix diagnosis cheat sheets won't include these new codes, but category 323.x was identified as a neurological case mix code in the original case mix list published in the PPS final rule, July 3, 2000, says Judy Adams, with Charlotte, NC-based LarsonAllen. While the Centers For Medicare & Medicaid Services has yet to confirm this formally, "the 13 new diagnoses should also be case mix diagnoses, worth 20 points if they are the primary focus of home health care," she says.

History confirms that these new codes will be added to the list of case mix diagnoses, notes Selman-Holman. Any new codes in years past that fit within the categories listed in the original lists of case mix diagnoses have been added to that list, she says.

Some of the new codes, like 323.41 (Other encephalitis and encephalomyelitis due to infection classified elsewhere) and 323.42 (Other myelitis due to infection classified elsewhere) are manifestation codes, notes Selman-Holman. These codes will bring you case mix points if they are listed in the first secondary position (M0240b).

Note: To sign up for Eli's Aug. 24 audio conference "2007 ICD-9 Coding Update for Home Health," call 1-800-508-2582.