Home Health & Hospice Week

Providers get no grace period for update.

It's that time of year again already--time to learn the new diagnosis codes or risk claims rejections or downcodes.

Watch out: Thanks to HIPAA, providers no longer have any grace period to get used to new codes. Your coders will have to hit the ground running Oct. 1.

Here are the coding changes most likely to affect home care providers:
 
• Diabetic retinopathy. With the new codes, you'll have more specific choices for diabetic retinopathy. In addition to codes for proliferative retinopathy, new codes have been added for nonproliferative retinopathy, notes coding expert Ann Zeisset with the American Health Information Management Association.

Specifically, the latest ICD-9 changes include four codes you can use to specify different types of nonproliferative diabetic retinopathy: 362.03 (Nonproliferative diabetic retinopathy NOS [not otherwise specified]); 362.04 (Mild nonproliferative diabetic retinopathy); 362.05 (Moderate nonproliferative diabetic retinopathy); and 362.06 (Severe nonproliferative diabetic retinopathy).

Further, you'll find a new code for diabetic macular edema (362.07). Remember, a patient must have retinopathy to have macular edema, so this new code creates yet another level of specificity within diabetes coding, says Zeisset.

• Renal failure. The standard chronic renal failure code (585) has been expanded to add a fourth digit specifying the stage of the condition. Also, the code has been reclassified as chronic kidney disease, "which includes chronic renal insufficiency along with chronic renal failure," explains Zeisset.

• Urinary obstruction. The long-standing code for urinary obstruction, 599.6, will become invalid. Instead, you must use either 599.60 (Urinary obstruction, unspecified) or 599.69 (Urinary obstruction, not elsewhere classified). These codes often will come into play for long-term, full-care cases, predicts consultant Lynn Yetman with Reingruber & Co. in St. Petersburg, FL.

Tip: Be sure to read the excludes notes before using these codes, Zeisset reminds coders. In some cases, you shouldn't use two codes to indicate urinary obstruction issues, and these notes will tell you what's correct.

• Fall codes. Add a new V code to your list: V15.88 (History of fall). "History of falls is a really good addition," cheers Yetman. "That's going to be widely used," she says, because it speaks to the patient's safety and need for physical therapy.

But while this code will see plenty of action, "it won't fit into the case mix diagnosis," points out Mary St. Pierre with the National Association of Home Care & Hospice. Though the code won't make a difference to payment, you should still use it as appropriate.

Caution: You'll usually use V15.88 for historical value only, instructs Zeisset. Typically, a history of falls would not be the primary reason for being under a home health plan of care. If there is an underlying reason for the patient's tendency to fall (such as Parkinson's, dementia, or even abnormality of gait), that is the focus of home care, and you'd report that condition in M0230.

The same usually goes for other "history of" codes, including the new one for history of recurrent pneumonia (V12.61), though there could be exceptions. For example, "if the patient is coming out of the hospital after a bout with pneumonia, home care is ordered and the patient no longer has pneumonia, the chief reason for admission may be the history of pneumonia (V12.61)," notes consultant Lisa Selman-Holman with Selman-Holman & Associates in Denton, TX.

• Orthopedic device complications. In the past, coders had only a four-digit nonspecific code for orthopedic device complications at their disposal (996.4). But a new nine-code series from 996.40 to 996.49 allows you to specify the type of complication, thereby painting a clearer picture of the patient, Zeisset notes. "We're doing much more for people with knees, joints and other kinds of prosthetics," so these new codes will be useful, Yetman says.

"If a patient has had surgery and is being treated for a complication, it would be incorrect to use the V codes for aftercare," Zeisset advises. Instead, you'd use a complication code in M0230, she says, "and codes 996.40-996.49 will provide more specificity." 

Note: For more information on diagnosis coding, see Eli's Home Health ICD-9 Alert at www.elihealthcare.com or by calling 1-800-874-9180.