Home Health & Hospice Week

If you miss getting a diagnosis code into M1024, it could decrease your Medicare reimbursement. Make certain you're completing M1024 correctly with the following tips from attorney and coding expert Lisa Selman-Holman of Selman-Holman & Associates and CoDR -- Coding Done Right in Denton, Texas.

1. First and most importantly, avoid excessive use of V codes in M1020/M1022 which will lessen the need to complete M1024, Selman-Holman urges. If you do list a V code in the primary or secondary diagnosis slots, make sure that it is correct and not unnecessary.

For example: Some common inappropriate uses of V codes include listing V58.6x (Long term [current] drug use) codes as primary and reporting V58.3x (Attention to surgical dressings and sutures) codes when the wound is complicated.

Hint: You'll generally list an aftercare V code as primary when providing aftercare, but any additional V codes that further specify the type of care you are providing do not have to be sequenced next.

2. Be sure the diagnosis you place in M1024 is actually the underlying diagnosis to the V code.

For example: If your V code is V55.3 (Attention to colostomy), then the underlying diagnosis would be the reason why the patient has the colostomy. For example: bowel cancer, diverticulitis, or bowel obstruction.

3. Try to restrict the use of M1024 to case mix diagnoses.

Problem: Some software is built to encourage the use of M1024 any time a V code is used in column 2. Software set up this way isn't following Centers for Medicare & Medicaid Services guidance, warns coding expert Sparkle Sparks with Redmond, Wash.-based OASIS Answers.

Consider that columns 1 and 2 are placed on the plan of care and column 2 is placed on the claim. These diagnoses are the current, unresolved diagnoses that are pertinent to the plan of care. If a case mix diagnosis is listed in these two columns, it will be counted and you will earn the appropriate points as long as the other criteria are met.

Mistake: M1024 isn't the only place you can list a code for case mix points, Selman-Holman says. This misunderstanding may lead to an excessive use of V codes, she warns.

Example: "I have seen coders list V58.31 (Encounter for change or removal of surgical wound dressing) as the first diagnosis and then list a post-op complication in M1024," Selman-Holman says. These coders mistakenly believe that they have to put the post-op complication code in M1024 to get points. "I can think of no time that a post-op complication would go in M1024 because a V code is not appropriate in this example. The post-op complication belongs in M1020 or M1022, not in M1024," she says.