Home Health & Hospice Week

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Don’t count on yet another ICD-10 delay as the Oct. 1 transition to the new coding set approaches. Congress and CMS seem intent on sticking to the ICD-10 deadline this time. Make certain your agency is on course as the new deadline approaches.

Save the date: The Centers for Medicare & Medicaid Services announced last July that Oct. 1, 2015 is officially the deadline for ICD-10 implementation. For claims with dates after Sept. 30, 2015, CMS will no longer accept ICD-9 codes.

For home health agencies, the new deadline means it’s time to get your 2015 transition preparations back on track even though you might have gotten burned with the delay last year. 

To make certain your agency is on target, you’ll need to begin your transition efforts ASAP. The transition to ICD-10 will have an impact on operations far beyond coding.

You’ll need to develop an implementation strategy tailored to your agency’s specific needs. Be sure to assess the impact of the new code set on all aspects of your agency, establish a detailed timeline of your agency’s transition process, and determine a realistic budget, advises coding expert and attorney Lisa Selman-Holman with Selman-Holman & Associates and CoDR — Coding Done Right in Denton, Texas.

A smooth ICD-10 transition goes beyond the walls of your agency. Be sure to check with your billing service, clearinghouse, or  software vendor to find out about their transition plans, Selman-Holman says. If your agency handles billing and software development internally or if you use paper forms, establish plans for medical records/coding, clinical, IT, and finance staff to coordinate on the transition, she says.

And if your agency’s software isn’t ready to convert to ICD-10 in October, CMS has a potential solution available. “If you will not be able to complete the necessary systems changes to submit claims with ICD-10 codes by October 1, 2015, you should investigate downloading the free billing software that CMS offers via their MAC websites,” CMS says in MLN Matters article SE1409.

“The software has been updated to support ICD-10 codes and requires an internet connection. This billing software only works for submitting FFS claims to Medicare. It is intended to provide submitters with an ICD-10 compliant claims submission format; it does not provide coding assistance,” CMS adds in the article.

Master These Key Coding Issues

CMS and the American Health Informa-tion Management Association (AHIMA) recommend starting extensive ICD-10 training by now. But coders and clinicians have more things they need to do to prepare for the deadline.

Selecting the most accurate ICD-10 codes will require more thorough documentation, and you should work on efforts to improve the data contained in the medical record.

ICD-10 coding isn’t the only change facing the home health industry that will require more detailed information in the medical record. The need for improved documentation is being driven by initiatives such as quality measures, value based purchasing, and patient safety, points out certified coder and nurse Sharon Molinari, a home health consultant based in Henderson, Nev.

Try this: Begin by reviewing medical rec-ord documentation for the conditions your agency codes most frequently, Molinari says. Then, identify medical record documentation improvement opportunities.

Bottom line: High quality documentation will increase the benefits of the ICD-10 coding system and give your agency a head start on the requirements of other initiatives for complete and accurate documentation that supports the diagnoses and services you provide.

Training tip: While coders need training on the new coding system itself, they can begin preparing by boning up on anatomy and physiology and medical terminology, in general, Molinari says.

Make certain your agency’s ICD-10 training plan includes the following steps, Molinari advises:

1. Assess each coder’s strengths and weaknesses in knowledge of anatomy, physiology, pharmacology, and medical terminology.

2. Develop a plan to address weaknesses.

3. Increase ICD-10-CM awareness.

4. Read the 2014 ICD-10 Official Coding Guidelines.

5. Become familiar with the ICD-10 coding manual.

6. Become aware of documentation requirements.

In home health, reimbursement will be linked in part to precise coding. And accurate coding depends on thorough documentation, Molinari says. “Both are critical to your agency’s success currently and will also be in the ICD-10 environment,” she stresses.

Try this: Run a list of your top diagnoses (not just primary) and then look up those diagnoses in ICD-10, suggests Selman-Holman. Check to see how specific the documentation and information from your referral source needs to be in order to code that condition as specifically as possible. Then, educate your intake personnel and the referral sources on what kinds of information you’ll be looking for at referral time. Educate your clinicians about the documentation you’ll be expecting from them to support those diagnoses in terms of assessment and interventions. “An added bonus is that when you’re through, you’ll have a great ‘cheat sheet’ for your most often used codes,” she tells Eli.

Resource: MLN Matters article SE1409 is at  www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1409.pdf.

Note: For more information on the transition to ICD-10, subscribe to Eli’s Home Health Coding and OASIS Expert at www.aapc.com/codes/coding-newsletters/my-homeoasis-expert-alert.