Home Health & Hospice Week

Interactions between codes, OASIS items will shake things up in the new year.

Simple diagnosis coding mistakes could cost you big bucks under the revised prospective payment system, so you'd better make sure your coding is up to snuff.

PPS' clinical domain--now called the clinical dimension--will undergo these coding changes when the PPS refinements hit Jan. 1, noted consultant Mark Sharp in a recent Eli audioconference on the changes: • A greatly expanded list of case mix diagnosis codes. The Centers for Medicare & Medicaid Services will increase the current four case mix diagnosis groups (neurological, orthopedic, diabetes and burns and trauma) to 22 new groups with hundreds of codes.

Change from proposed rule: Those include two categories on ostomies tacked on since the proposed rule. CMS "added appropriate variables in both the case mix model and the [nonroutine supplies] model to capture patients with resource needs or supplies cost needs due to tracheostomy and urostomy/cystostomy," the agency says in the final rule issued Aug. 22. Three V codes make up those categories--V55.0 (Tracheostomy), V55.5 (Cystostomy) and V55.6 (Other artificial opening of urinary tract). • An expanded OASIS form with space for six diagnosis codes. PPS will count the diagnosis codes in the primary and secondary positions toward case mix. And  when a M0 item requires an accompanying diagnosis code to add points, PPS will count the diagnosis codes in all six positions. • M0246 will replace M0245 and allow for a replacement code when a non-paying V code bumps a case mix code out of the primary or secondary positions.

The new OASIS item is "looking at all diagnoses" listed, explained Sharp, with BKD in Springfield, MO. In M0246, CMS wants you "to put a corresponding non-V code diagnosis for all diagnoses that you might have as a V code in M0230 or M0240. That is new." • Scoring of diagnosis codes will be cumulative instead of just counting the highest-paying diagnosis group, as agencies do currently. Codes in the same case mix diagnosis group will not add together, however--only the highest-point diagnosis from the group will count. • Scoring of diagnosis codes and OASIS items often will depend on interactions between the two. Brace For More Complicated Case Mix Model Under the PPS refinements rule, the case mix model is much more complex, Sharp warned in his audioconference last month. That's due to two factors: 1. The new four-equation model awards different points to the same case mix items depending on which episode and therapy threshold the patient has.

Example: A diabetes primary diagnosis can add anywhere from 1 to 12 points depending on the equation, Sharp pointed out.

2. The new model awards different points de-pending on the interaction between diagnosis codes and OASIS [...]