Home Health & Hospice Week

Are you documenting everything you need to for coverage?

Your insulin-injection-based claims may not get denied for the diagnosis codes they contain, but those codes — or lack of them — may land you in the hot seat for medical review.

In its 2015 home health prospective payment system proposed rule issued in July, the Cen-ters for Medicare & Medicaid Services published a list of about 165 diagnosis codes that “indicate that a patient may not be able to self-inject” in home health. Multiple commenters blasted the list as being too limited (see Eli’s HCW, Vol. XXIII, No. 38).

“We have not proposed a policy that limits coverage to a list of conditions that would indicate why a home health beneficiary is unable to self-inject,” CMS responds in the 2015 HH PPS final rule issued Oct. 30.

However: “We identified these conditions as a means for providers and contractors to identify patients who may not be able to self-inject insulin,” CMS explains. In other words, your MAC or other CMS contractors may use the code list for medical review targeting, experts note.

CMS will consider codes submitted in the comment process for possible inclusion at a later time, the agency says in the rule.