Home Health & Hospice Week

Not sure what to do when you have a combination diagnosis code listed on the plan of care for the first code diagnosis, but you’re only providing home health for one of those conditions? One HHH Medicare Administrative Contractor has an answer.

“The face-to-face clinical encounter must be related to the primary reason for home health services. These conditions must be addressed within the encounter or be evident in documentation that has been authenticated by the allowed provider performing the face-to-face,” MAC Palmetto GBA explains in an April 7 post to its website. “Examples CAN include but are not limited to, medications for the condition, laboratory tests related to the diagnosis and past medical history conditions listed,” the MAC offers.

“Medical Review nurses utilize clinical judgement for the synthesis of the clinical documentation,” Palmetto explains. “Etiology and causative conditions are taken into consideration when the face-to-face documentation is sufficient to demonstrate the condition. The plan of care and interventions should address the etiology (first diagnosis code) as well as any other pertinent diagnoses.”