Home Health & Hospice Week

Diagnosis Coding:

AVOID THIS PITFALL WHEN USING NEW DIAGNOSIS CODES

Published on Tue Sep 20, 2005

Do you know when you still should use the old 2005 codes?

The new 2006 diagnosis codes have taken effect as of this month--but that doesn't mean you should always use them.

HIPAA no longer allows a grace period during which old codes are still accepted. However, home health agencies have a grace period of sorts in that they submit a request for anticipated payment (RAP) and then an end-of-episode claim, explains coding expert Lisa Selman-Holman with Selman-Holman & Associates in Denton, TX.

For the most part, the diagnosis codes on the RAP have to match those on the final claim. To keep your billing accurate, use the codes that are current on the initial date of the episode, advises Selman-Holman. So, if you have an episode that begins before Oct. 1 and ends after Oct. 1, use the 2005 codes.

Example: For a patient with chronic kidney disease with a start of care date or recertification in September 2005, use 585 (Chronic renal failure) on both the RAP and final claim. But if that patient's start of care date was on or after Oct. 1, use 585.x (Chronic kidney disease) on both the RAP and final claim.

Tip: Always base your code choice on the date of episode, not the date of assessment. For example, if you were doing the recertification assessment on the last day of September for a patient who was up for recertification on the first day in October, you would use the 2006 codes, counsels Selman-Holman.

Warning: The significant change in condition (SCIC) is the exception to this rule. If you change a diagnosis as a result of a SCIC, and you plan to bill the SCIC, then the diagnoses on your RAP and your final claim will not match, cautions Selman-Holman.

"In this case, use the current codes as of the date of the OASIS. If your SCIC occurs prior to Oct. 1, continue using the 2005 codes," Selman-Holman tells Eli. "If the SCIC is on Oct. 1 or after, use the 2006 codes," she advises.

Note: For more information on diagnosis coding, see Eli's Home Health ICD-9 Alert at www.elihealthcare.com/spec_health_icd-9.htm.

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