Home Health & Hospice Week

Your agency is eligible for nonroutine supply (NRS) reimbursement based on OASIS responses, even if you don't actually provide the supplies specific to the diagnosis, says coding expert Trish Twombly with Foundation Management Services in Denton, Texas.

How it works: NRS points are calculated based on OASIS responses and coding, not on the type of or quantity of supplies provided, says Lisa Selman-Holman with Selman-Holman & Associates and CoDR -- Coding Done Right in Denton, Texas. If supplies are not provided, the HIPPS code you report ends in a number. If NRS were provided, the HIPPS code ends in a letter.

Either way, you get paid for the nonroutine supply category indicated by your OASIS coding, Twombly notes.

In other words: "The NRS payment is calculated based on OASIS data and is not linked in any way to actual supply utilization," explains billing expert M. Aaron Little with BKD in Springfield, Mo. "Whether or not supplies were provided or billed has no impact on payment."

Keep in mind that when billing the NRSprovided HIPPS code ending in a letter, the claim needs to include the revenue code for the NRS and the charges only without specificity as to HCPCS codes, quantities and types of NRS, Selman-Holman points out.

Don't count on NRS reimbursement to stay this way forever. "It is assumed that at some point in the future, this could change," Little says.

NRS reimbursement is calculated using OASIS combinations; numerical case mix diagnoses; selected V codes; and seven case mix categories (see related story, p. 77).

Coding example: Your patient was admitted for chronic obstructive pulmonary disease (COPD) exacerbation, but also has type II diabetes mellitus with a diabetic ulcer on the right great toe. The diabetes is managed with an oral hypoglycemic and the patient requires continuous oxygen. Code for this patient as follows, says Twombly:

M1020a: 491.21 (Obstructive chronic bronchitis; with [acute] exacerbation);

M1022b: 250.80 (Diabetes with other specified manifestations; type II or unspecified type, not stated as uncontrolled);

M1022c: 707.15 (Ulcer of other part of foot); and

M1022d: V46.2 (Dependence on supplemental oxygen).

Your patient's COPD is the main reason you are going to the home, so this is your primary diagnosis listed in M1020, Twombly says. You'll list the underlying condition/manifestation code pair 250.80 and 707.15 next, but you won't gain any NRS points for this diabetic ulcer combination because the codes are listed as secondary diagnoses. But you will be eligible for 13 NRS points for reporting a non-pressure, non-stasis ulcer with 707.15, Twombly says.

Finally, list V46.2 to indicate to your intermediary just how decompensated your patient is, Twombly says.

On the other hand: If your focus of care were the patient's diabetic ulcer, you could list 250.80 in M1020a as the primary diagnosis code with 707.15 following in M1022b. This sequencing would earn you an additional 20 NRS points.

Key: "NRS points add to the bottom line," says certified coder and nurse Jan McLain with Adventist Health System Home Care in Port Charlotte, Fla.