Home Health & Hospice Week

Tip: Be sure your policy on correcting diagnosis coding is crystal clear.

Can you override the assessing clinician who chooses a manifestation code as primary?

Suppose you are reviewing a start of care (SOC) assessment, for a patient who is receiving wound care from your agency for a chronic diabetic ulcer on the right heel. The diagnosis code in M1020 — Primary Diagnosis is 707.14 (Ulcer of lower limbs, except pressure ulcer, heel and midfoot). The corresponding etiology code 250.80 (Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled) isn’t among the codes in M1020 — Other diagnoses. You know that this is a mistake because according to coding guidelines, the manifestation code shouldn’t be in the primary diagnosis spot — the underlying etiology code should be there instead.

Question: Can you consider this situation a technical coding "error" and follow your agency’s correction policy allowing you as the coding expert to correct this error, without conferring with the assessing clinician?

Answer: No, says the Centers for Medicare & Medicaid Services in the Category 4b — OASIS Data Items issued in June. "If the assessing clinician identifies the diagnosis that is the focus of the care and reports it in M1020, and ICD-CM coding guidelines required that the selected diagnosis is subject to mandatory multiple coding, the addition of the etiology code and related sequencing is not a technical correction because a diagnosis is being added."

Even when the coding for a patient is incorrect because the guidelines require you to list an additional diagnosis, you must first contact the assessing clinician and get her buy-in before adding a code.

Why? When you question the accuracy of the primary diagnosis the assessing clinician chose, the problem goes beyond being a "technical" error.

If you discuss the manifestation coding situation with the assessing clinician and she agrees that you should modify the sequence of the diagnosis codes to more accurately reflect the diagnosis that is most related to the current plan of care following current ICD-CM coding guidelines, you can make the change according to your agency policy, CMS allows.

Note: For more information on OASIS and diagnosis coding, subscribe to Eli’s Home Health Cod-ing and OASIS Expert at www.aapc.com/codes/coding-newsletters/my-homeoasis-expert-alert.