Home Health & Hospice Week

Grace period elimination means you'd better be up to speed on the new codes by Oct. 1.

The changes to the ICD-9-CM diagnosis codes are out, and much more specific codes for decubitus ulcers are the biggest change for many home care folks.

"Any time the codes change, there is the possibility of claims rejecting if billed with the old codes," warns reimbursement consultant M. Aaron Little with BKD in Springfield, MO. Claims with invalid codes return to provider (RTP), "which could slow down cash flow and result in extra time spent correcting documentation as well as claims," Little notes.

And now that the 90-day grace period for new diagnosis codes has been eliminated, you had better have the coding changes down cold by Oct. 1 or face the reimbursement consequences. "We're going to have to be able to hit the ground running with these new codes -- agencies and vendors alike -- on Oct. 1, 2004," worries Ida Blevins, supervisor of reimbursement and information management for St. John's Hospital Home Health Services in Springfield, IL.

Agencies "need to be aware of the upcoming new diagnosis codes and instruct their coders and/or staff on their availability prior to Oct. 1," Blevins stresses. HIPAA required scrapping the grace period, the Centers for Medicare & Medicaid Services explained in February (see Eli's HCW, Vol. XIII, No. 6).

"New and changed codes must be entered into the home health agency's systems ASAP," adds consultant and credentialed coder Lynda Dilts-Benson with St. Petersburg, FL-based Reingruber and Co.

Here are the diagnosis code changes most likely to impact home care providers, experts say:

-- Decubitus ulcers -- 707.00 (Decubitus ulcer, unspecified site), 707.01 (Decubitus ulcer, elbow), 707.02 (Decubitus ulcer, upper back), 707.03 (Decubitus ulcer, lower back), 707.04 (Decubitus ulcer, hip), 707.05 (Decubitus ulcer, buttock), 707.06 (Decubitus ulcer, ankle), 707.07 (Decubitus ulcer, heel), and 707.09 (Decubitus ulcer, other site).

Currently, the only code for a decubitus ulcer is the "very non-specific" 707.0, points out Jennifer Andres, health information & compliance coordinator for St. Luke's Home Health Services in Duluth, MN. "After October, the code choices for decubitus ulcers will include the location of the ulcer. The increased specificity is a great benefit to clinicians, physicians, billing, auditing, reporting, etc.," Andres says.

"The code now requires five digits instead of the four we were used to, which will lead to many claims being returned to the providers and a delay in payments," Dilts-Benson warns.

-- V codes. HHAs are likely to use two new aftercare codes, suggests coding expert Prinny Rose Abraham, consultant with HIQM Consulting in Minneapolis -- V58.67 (Long-term [current] use of insulin) and V58.66 (Long-term [current] use of aspirin). "We will use" the insulin code "with some degree of frequency," Blevins predicts.

-- Bronchitis. The code for obstructive chronic bronchitis with acute bronchitis (491.22) is likely to impact home care folks, Abraham judges.  

-- Venous embolism -- 453.40 (Venous embolism and thrombosis of unspecified deep vessels of lower extremity), 453.41 (Venous embolism and thrombosis of deep vessels of proximal lower extremity) and 453.42 (Venous embolism and thrombosis of deep vessels of distal lower extremity).
 
Blevins expects to see the venous embolism codes used at St. John's, she tells Eli.

-- Descriptors. It's not just outright coding changes that will affect HHAs, Dilts-Benson notes. Changes to the code descriptors, rather than the codes themselves, also will affect how agencies code.

"The descriptor for the diabetes codes no longer makes reference to insulin use or non-use," Dilts-Benson points out. That change is likely to trip up HHAs' diabetes coding in the 250 series because "many in the health care industry erroneously used the insulin connection to choose the diabetic codes," she says.

"The only factors utilized in the decision as to which codes to use should always have been Type I or Type II, controlled or uncontrolled," Dilts-Benson says.

"Home care agencies that are involved in mental health" should note that descriptors also have changed for a wide range of mental health diagnoses, Andres highlights. 

Editor's Note: The coding changes are available at www.cms.hhs.gov/medlearn/icd9code.asp.