Home Health & Hospice Week

Home care coders must wrestle with their own scarlet letter during transition.

As confusing as the current guidance — or lack thereof — is for the seventh character in ICD-10 coding, the direction to sometimes use “A” opens up even more issues.

Problem: The lack of concrete guidance on selecting an appropriate seventh character in home health means that the Oct. 1 ICD-10 implementation deadline likely will arrive without coders knowing what they should report in the seventh character position for complications. The guidance that agencies do have presents a slippery slope, says coding expert Lisa Selman-Holman of Selman-Holman & Associates, CoDR — Coding Done Right and Code Pro University in Denton, Texas. For example, IV antibiotics will clearly require an “A” in the seventh character position of the code for the complication being treated. But what if the patient is changed to oral antibiotics prior to returning home — is that considered ongoing care?

Another problem: In addition to the issues brought about by the uncertain guidance, ICD-10 codes with “A” as the seventh character aren’t included in the case mix grouper. This means that those patients who are more acutely ill and require more care will not receive case mix points, Selman-Holman says.

If codes with “A” as the seventh character don’t receive case mix or Nonroutine Supplies (NRS) points, that means claims spanning Oct. 1 to Dec. 31 2015 with a diagnosis for wound dehiscence, post-op infection of surgical wound, or a non-healing surgical wound could be negatively impacted, warns the National Association for Home Care & Hospice.

Possible solution: Agencies hope CMS will consider changing the case mix scoring for the Jan. 1 case mix changes, and possibly make the change retroactive.

Note: The code for non-healing surgical wound is not currently case mix. CMS has been notified that it needs to be changed to case mix, Selman-Holman says.

All affected claims will likely need to be adjusted, since there is little time left to make changes to the grouper before the ICD-10 deadline, NAHC predicts.