Home Health & Hospice Week

You should hone your coding of conditions related to the two eliminated hypertension codes to earn your rightful reimbursement under home health prospective payment system.

The Centers for Medicare & Medicaid Services defends its decision to eliminate the hypertension codes from the case mix calculation. "The two codes 401.1 and 401.9 are not associated with additional resource use," the rule explains. "Therefore, we believe that the two codes should be removed from our case-mix system."

The codes used to be associated with additional resources back when the prospective payment system was first created. But after CMS made PPS refinements in 2008 resulting in the 153-group case mix model, hypertension prevalence more than doubled compared to 2005 levels, CMS points out. The reason the codes now don't indicate resource usage may be because they are used much more often for less severe patients, CMS theorizes.

The problem: "Home health agencies have overutilized this code without supporting documentation that the patient has an issue with HTN," says Lynda Laff with Laff Associates in Hilton Head Island, S.C. "Home health agencies often used these HTN case mix codes either as a primary diagnosis or in the second, third, or subsequent recertifications as a means to both garner three case mix points and/or to keep the patient on services."

The solution: "The underlying heart disease or kidney disease should be coded -- these codes are case mix codes," Laff instructs. Those related and underlying conditions often will garner the three case mix points for that diagnosis anyway.

But remember, "these codes are only to be used when the patient diagnosis of Hypertensive cardiac disease or Hypertensive Kidney disease is present and validated," Laff counsels. HHAs should make sure coders are educated about using codes in the 402 and 403 categories.

Also, "agencies need to make certain that they continue to code HTN if it is a diagnosis that they will be managing and addressing in the plan of care and visit notes," Laff advises.

"Providers who have been doing the right thing all along [probably won't] feel a major impact from the elimination of HTN codes," Laff judges. "The majority of the time if HTN is truly an appropriate code to use, the patient also actually does have other comorbidities and it will likely be appropriate to code the combination code for the comorbidity."