Home Health & Hospice Week

Incorrect diagnosis code reporting could bounce your claims back to you when new edits hit.

You may be looking ahead to ICD-10 implementation, but perhaps you should be paying more attention to ICD-9 in the meantime.

Why? On Jan. 1, the Centers for Medicare & Medicaid Services will implement edits that will return home health agency claims that contain a manifestation code as primary. Under ICD-9 coding conventions, a manifestation code may only be listed after the code for its underlying condition.

“An analysis of Outcome Assessment and Information Set (OASIS) records and claims for CY 2011 revealed that some agencies were not complying with the coding guidelines when reporting the primary diagnosis, in particular with regards to certain codes that require the underlying condition be sequenced first followed by the manifestation,” CMS says in Change Request 8813. “Given the concerns regarding compliance with coding guidelines, CMS is adopting edits to ensure greater compliance of coding guidelines for primary diagnosis codes.”

Do this: “The principal diagnosis reported on the home health claim shall be the ICD-9-CM code that is most related to the current home health plan of care,” CMS instructs. “HHAs shall not submit manifestation codes as the primary diagnosis.”

The CR is at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1405OTN.pdf.