Home Health & Hospice Week
Bone Up Now On 6 Major Changes to Home Care Coding
Avoid new coding pitfalls that could cost you case mix points. With the 122 new, deleted, or revised ICD-9 codes that took effect Oct. 1, make certain you're ready to tackle these changes that are impacting home care the most. 1. New Status Codes for Absence of Pancreas. New codes V88.11 (Acquired total absence of pancreas) and V88.12 (Acquired partial absence of pancreas) offer greater specificity. In turn, notes under new subcategory V88.1 (Acquired absence of pancreas) ask that you use an additional code to identify any associated insulin use (V58.67) or secondary diabetes mellitus (249.00-249.91), says certified coder Joan L. Usher with JLU Health Record Systems in Pembroke, Mass. 2. Hemochromatosis. Of several new codes under 275.0 (Disorders of iron metabolism), 275.02 (Hemochromatosis due to repeated red blood cell transfusions) has special interest for home care, says certified coder and attorney Lisa Selman-Holman of Selman-Holman & Associates and CoDR -- Coding Done Right in Denton, Texas. 3. Fluid Retention. Subcategory 276.6x (Fluid overload) gains a fifth digit this year, adding new codes 276.61 (Transfusion associated circulatory overload) and 276.69 (Other fluid overload). Tip: Watch for excludes notes under 428.0 (Congestive heart failure, unspecified) and 782.3 (Edema) that advise you not to list 276.69 for patients with these conditions, Usher says. Review HTN CKD: Includes Category 403 (Hypertensive chronic kidney disease) has a revised "Includes" note, adds Selman-Holman. Until further clarification is received, Selman-Holman recommends using fifth digit "0" (with chronic kidney disease stage I through stage IV, or unspecified) unless some documentation of CKD is also present. 4. Symptom Codes. Several common symptoms have new or updated codes, Selman Holman says. These include 780.33 (Post traumatic seizures); 780.62 (Postprocedural fever); 786.39 (Cough with hemorrhage); and four new incontinence of feces codes in 787.6x. 5. V codes. Check out clarifications for V07.x (Need for isolation and other prophylactic measures); V45.02 (Automatic implantable cardiac defibrillator); V53.3x (Fitting and adjustment of cardiac device). 6. BMI. BMI listings for adults are now very specific, with V85.4x (Body Mass Index 40 and over, adult) gaining a fifth digit, Selman-Holman says. Warning: Auditors could move your other codes in the top six slots down if you leave off the BMI code, Usher says. If you had a case mix diagnosis sequenced last, you might end up losing points. Note: For more detailed discussion of the new ICD-9 diagnosis codes that take effect Oct. 1, see Eli's Home Health ICD-9 Alert online at www.elihealthcare.com.
Home Health & Hospice Week
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