Home Health & Hospice Week

Diagnosis coding will be more important than ever to your bottom line.

You have a few short weeks to finish preparing for the prospective payment system refinements that take effect Jan. 1, so you'd better make the most of your time to ease the transition.

A major area for your focus in these last days should be diagnosis coding, experts agree. Under the PPS refinements, diagnosis coding plays a much bigger part in how Medicare calculates your episode reimbursement.

Caution: Often, you won't get case mix points for an episode unless a diagnosis accompanies another diagnosis or M0 item answer (see Eli's HCW, Vol. XVI, No. 35). And diagnoses in all six positions of M0230/M0240/M0246 count toward payment.

Soak up information on how the new M0246 item works, advises consultant Lisa Selman-Holman with Selman-Holman & Associates in Denton, TX. Now that PPS counts secondary diagnoses toward payment, it will be crucial for clinicians to understand how case mix codes bumped by V codes in M0240 are counted in the revised OASIS item.

"Teach the assessing clinicians the importance of collecting information about co-morbidities the pa-tient may have," Selman-Holman tells providers. Any of the diagnoses for those conditions may increase your rightful reimbursement.

Do this: Have your clinicians practice scoring numerous episodes under the new PPS rules, recommends consultant Pam Warmack with Clinic Connections in Ruston, LA. Thanks to such practice, "clinicians, especially nurses, are demonstrating a better understanding of the changes and the impact of their assessments and coding on reimbursement," Warmack reports. Tighten Up Your Coding Specificity Make sure you're not going to lose case mix points and hard-won reimbursement due to insufficient coding, Warmack warns. If the diagnoses you commonly use in M0230 and M0240 aren't on the newly expanded case mix list, it could be because you aren't using specific enough codes.

Example: The non-specific code for Chronic Obstructive Pulmonary Disease (496.0) isn't on the case mix list under the PPS revisions, but several more specific COPD-related conditions are: Emphysema (492), Chronic Obstructive Asthma unspecified (493.20), Chronic Obstructive Asthma with Status Asthmaticus (493.21) and Chronic Obstructive Asthma with Acute Exacerbation (493.22), Warmack points out.

"Try to be more specific and therefore you will potentially capture more co-morbidity coding points," she counsels.

Coding is so important under the new PPS methodology that consultant Betty Gordon advises all home health agencies to hire certified coders to handle it. HHAs should use certified coders because of their initial training and, more importantly, the requirement than they receive ongoing updates and education.

This is controversial advice, Gordon acknowledges. But "you can't have every nurse trying to decide on the codes," maintains Gordon, with Simione Consultants in Westborough, MA.

Don't forget: And choosing the appropriate code isn't the end of the matter. You [...]