Home Health & Hospice Week

New coding-focused edit took effect Jan. 1.

You’d better put a manifestation diagnosis coding refresher on your long to-do list this month.

Reminder: On Jan. 1, a new Medicare claims edit kicked in that returns home health agency claims if they list a manifestation code as primary. The Centers for Medicare & Medicaid Services set the Jan. 1 implementation date in a transmittal issued last August. (For tips on dealing with the new edit, see Eli’s HCW, Vol. XXIII, No. 34).

“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 said 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 should be the ICD-9-CM code that is most related to the current home health plan of care,” CMS directs in a MLN Matters article linked to the CR. “HHAs should not submit manifestation codes as the primary diagnosis.”

See the MLN Matters article at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8813.pdf.