Home Health & Hospice Week

Get ready for your coding to get more complex when new codes take effect Oct. 1.

If you’ve got the hang of coding for two of home care’s most common issues--diabetes and ulcers--get ready for a new learning curve.

The Centers for Medicare & Medicaid Services plans to debut more than 300 new diagnosis codes Oct. 1. Coders may welcome some more specific codes, but the added details and additional codes may wind up making ulcers and diabetes more confusing to code.

CMS released the changes in the 2009 Inpatient Prospective Payment Systems proposed rule (available at http://edocket.access.gpo.gov/2008/pdf/08-1135.pdf).

Pressure Ulcers: Currently, when you choose a 707.0x (Ulcer of lower limbs, except decubitus) code for a pressure ulcer, you can indicate the site of the ulcer but not the stage. With the proposed changes, you’ll be able to indicate the stage with the following new codes:  • 707.21 (Pressure ulcer, stage I);
 • 707.22 (Pressure ulcer, stage II);
 • 707.23 (Pressure ulcer, stage III); and
 • 707.24 (Pressure ulcer, stage IV). These new codes will better identify the level of care required by the clinician, says certified coder Shelley C. Safian, program director and instructor with Herzig College in Longwood, FL.

Drawback: These codes could make ulcer coding even more complicated. Because you can’t reverse stage an ulcer, these codes won’t show the progress of the ulcer, says certified coder and attorney Lisa Selman-Holman of Selman-Holman & Associates in Denton, TX. So, for example, if the ulcer is stage IV, you would always code it as stage IV--even once it has healed, she says.

Diabetes: CMS will introduce 20 long-awaited new codes to represent secondary diabetes conditions (249.00-249.91). This is an acknowl-
edgement that other underlying conditions can create a diabetic situation, says Safian. These conditions include cystic fibrosis, malignant neoplasms and genetic disorders.

You’ll need to include five digits to completely code for secondary diabetes when these new codes go into effect. The fourth digit indicates the diabetic manifestation while the fifth digit indicates whether the diabetes is controlled. For example, 249.50 indicates secondary diabetes mellitus with ophthalmic manifestations, not stated as uncontrolled, or unspecified.

The manifestations are expected to mimic the manifestations under code 250, says Selman-Holman. Many of the manifestations of diabetes are case mix diagnoses, so it will be interesting to see whether CMS will include the etiology of 249 as an acceptable etiology for the manifestations, she says.

Use with caution: Home health coders won’t often use these new diabetes codes, predicts [...]