Home Health & Hospice Week

Is your coding prep paying off?

Home health agencies have said goodbye to ICD-9 coding — almost.

Remember: “Medicare requires the use of ICD-10 codes on HH claims and Requests for Anticipated Payment (RAPs) with a THROUGH date on or after October 1, 2015,” the Centers for Medicare & Medicaid Services says in its ICD-10 frequently asked questions for home health. That means if you’re still submitting claims for episodes that ended before Oct. 1, you should still include ICD-9 codes on them.

Another transition exception is for payers who are still accepting only ICD-9 codes. That includes Medicaid programs in California, Louisiana, Maryland and Montana.

It was up to HHAs whether they practiced so-called dual coding for claims spanning Oct. 1. “Medicare does not require ICD-10 coding of these episodes in advance of the ICD-10 implementation date,” CMS noted in the FAQ. “Home Health Agencies should determine whether identifying the ICD-10 codes in advance will benefit them.” ICD-10 codes were not permitted on claims before Oct. 1.

Whether they practiced dual coding or not, home health coders are struggling to familiarize themselves with the expanded coding set and coordinate ICD-10 codes with payment. You can get help with that effort with these resources:

• CMS’s MLN Matters Article SE 1410 outlines billing rules under ICD-10, including that “HHAs do not have to re-group the episode based the ICD-10-CM codes” when it spans Oct. 1 and the RAP includes ICD-9 codes. “But this could result in some inconsistency between the HIPPS code and the ICD-10-CM codes on the claim. CMS will alert medical reviewers at our MACs to ensure that the ICD-10-CM codes on these claims are not used in making determinations.” www.cms.gov/Outreachand-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1410.pdf
• This Blue Cross Blue Shield of Michigan tip sheet on HHAs’ top 20 diagnoses codes includes facts like “Diabetes mellitus (E08-E13) is no longer classified as controlled or uncontrolled in ICD-10-CM,” as well as a chart mapping ICD-9 to ICD-10 codes. www.bcbsm.com/content/dam/public/Providers/Documents/help/faqs/icd10-tipsheethome-healthcare.pdf
• If you ignored ICD-10 for too long, CMS’s two-page quick start guide may help you catch up. www.cms.gov/medicare/coding/icd10/downloads/icd10quickstartguide20150622.pdf
• CMS offers a vast array of ICD-10 resources, including a video link on how to convert the HH PPS grouper to ICD-10. www.cms.gov/Medicare/Coding/ICD10/Medicare-Fee-For-Service-Provider-Resources.html
• CMS and its contractors are standing by to help you with problems as you transition to ICD-10, pledged ICD-10 Ombudsman Bill Rogers in a message to providers. “Your first line for help for Medicare claims questions is to contact your Medicare Administrative Contractor,” Rogers instructed.

“They’ll offer their regular customer service support and respond quickly.” You can also contact the ICD-10 Coordination Center at icd10@cms.hhs.gov or Rogers at icd10_ombudsman@cms.hhs.gov, he added. “We’ll respond to your questions,” he promised. “I’ll be an impartial advocate for providers, focused on understanding and resolving your concerns,” he continued.