Home Health & Hospice Week

Remember way back last summer when the Centers for Medicare & Medicaid Services said it would be requiring the use of V codes for home health agencies? Well, now is the time to start dealing with the change.

The Health Insurance Portability and Accountability Act requires adherence to all ICD-9 coding conventions, including the correct use of V codes. CMS had previously banned the use of those codes in OASIS, and thus home health billing, because they were too broad to be helpful in determining case mix, explained coding expert Prinny Rose Abraham in an April 7 presentation at the National Association for Home & Hospice Care's annual policy conference in Washington, DC.

Thanks to HIPAA, CMS has set Oct. 1 -less than six months away - as the date HHAs must start using the V codes, which represent aftercare services for injury or disease. And to capture payment information that might be lost, CMS has added OASIS item M0245 that will go into effect at the same time. Agencies must use M0245 to report these aftercare services, or risk losing out, said Abraham, with Minneapolis-based HIQM Consulting.

CMS says in its OASIS instructions that M0245 is an optional item, but that's only true if HHAs see obtaining their correct reimbursement as optional, Abraham warned.

Many HHAs are still in the dark about M0245, said Joie Glenn with the New Mexico Association for Home Care, who attended the session. Providers that don't train their coders appropriately on the new OASIS item could face major reimbursement shortfalls, Glenn feared.

Agencies should treat M0245 as another skip pattern in the OASIS document, Abraham advised. If a V code is present in M0230 (primary diagnosis), HHAs should determine if the diagnosis it replaces is a "case mix diagnosis" - one that makes a difference to payment under the current, pre-October 2003 coding rules, Abraham counseled. If so, agencies should place the case mix diagnosis in M0245 to receive payment for that diagnosis.

What are case mix diagnoses? Those neurological, orthopedic, diabetic and trauma codes listed in Table 8 of the prospective payment system regulation, which add from 11 to 21 points to the clinical dimension of the patient's case mix category.

To assist with the skip pattern, HHAs can mark those diagnoses in their coding books or information systems or purchase coding books where they already are marked, Abraham suggested.

Come October, this should become an automatic pattern to make sure you're receiving your rightful reimbursement:

1) Check for V code in M0230.

2) If no, skip M0245. If yes, go to 3.

3) Check if the V code is used in place of one of the codes on your case mix diagnoses list. If no, skip M0245. If yes, place the case mix diagnosis in M0245.

Occasionally, to receive the increased payment, agencies will have to place both a primary diagnosis and a manifestation code that is the case mix diagnosis and secondary diagnosis in lines A and B of M0245, just as they currently are in lines A and B of M0230, Abraham added.

HHAs will want to perform just-in-time training to avoid confusing their staff before the Oct. 1 deadline, Abraham recommended. But agencies also want to make sure staff responsible for coding understand the changes come October so they don't miss out on any reimbursement that should come their way. OASIS and Medicare systems won't accept M0245 until the deadline passes.

The training timeline will vary depending on how many clinicians, coders, billers or other staffers agencies must train and how easily and quickly agencies can make changes to their paper or electronic OASIS assessment forms, she noted. For many agencies, training time will fast be approaching.

"On Oct. 1 we have to turn on a dime and start completing things differently," she stressed.