Home Health & Hospice Week

Diagnosis Coding:

Pin Down These NRS Diagnoses For Fair Reimbursement

Published on Fri Feb 11, 2011

Mind your sequencing to get all the case mix points you're entitled to.

Under the prospective payment system, sequencing impacts the number of nonroutine supplies points you'll earn for reporting diagnoses in the seven selected case mix categories.

When a diagnosis from one of these categories is the focus of your care and reported as primary in M1020, you're eligible for more points than when the same diagnosis is reported in M1022. The difference breaks down as follows, reports coding expert Trish Twombly with Foundation Management Services in Denton, Texas:

Cancer diagnoses

172.x (Malignant melanoma of skin)

173.x (Other malignant neoplasm of skin)

Listed as primary: 15 NRS points

Listed as secondary: 4 NRS points

Diabetes diagnoses

250.8x (Diabetes with other specified manifestations) paired with manifestation 707.1x (Ulcer of lower limbs except pressure ulcer).

249.8x (Secondary diabetes mellitus with other specified manifestations) paired with manifestation

707.1x (Ulcer of lower limbs except pressure ulcer).

Listed as primary: 20 NRS points

Listed as secondary: 0 NRS points for diabetic ulcer, however the ulcer code gains 13 points as a Skin 2 code.

Skin 1 diagnoses

Trauma (open) wounds/burns

Complicated surgical wounds:

Dehiscence

Infection

Foreign body accidentally left during procedure

Non-healing

Persistent fistula

Listed as primary: 19-23 NRS points

Listed as secondary: 8-15 NRS points

Ortho 1 diagnoses

897 (Traumatic amputation of leg[s] [complete] [partial])

Listed as primary: 19 NRS points

Listed as secondary: 8 NRS points

Skin II diagnoses

Abscess

Cellulitis

Gangrene

Ulcers

Listed as primary: 11-16 NRS points

Listed as secondary: 7-13 NRS points

Tracheostomy

V55.0 (Attention to tracheostomy)

Note: You must be doing something to or about the ostomy to earn NRS points.

Listed as primary: 23 NRS points

Listed as secondary: 23 NRS points

Note: You will earn 0 NRS points if the ostomy is infected because you can't report a V code when there is a complication.

Urostomy/Cystostomy

V55.5 (Attention to cystostomy)

V55.6 (Attention to other artificial opening of urinary tract)

Note: You must be doing something to or about the ostomy to use the V55 code to earn NRS points. Cystostomy listed as Primary or Secondary: 16 points Urostomy listed as Primary or Secondary: 24 points.

Note: You will earn 0 NRS points if the ostomy is infected because you can't report a V code when there is a complication.