Home Health & Hospice Week

Watch for these case mix additions and deletions that took effect Jan. 1.

The loss of case mix points for hypertension codes 401.1 (Benign essential hypertension) and 401.9 (Unspecified essential hypertension) weren't the only case mix changes the 2012 home health PPS final rule brought about. Take note of these additional updates to the diagnosis codes eligible for case mix points.

• Dementia: At first the new 2012 dementia codes 294.20 (Dementia, unspecified, without beha-vioral disturbance) and 294.21 (Dementia, unspecified, with behavioral disturbance) seemed to have been left off the case mix diagnosis code list, despite the fact that the 2011 code for dementia, NOS is 294.8 was a case mix code.

However, efforts to correct this problem by industry members including Eli contributing editor and coding expert Lisa Selman-Holman of Sel-man-Holman & Associates and CoDR -- Coding Done Right in Denton, Texas helped move the Cen-ters for Medicare & Medicaid Services to update the home health prospective payment system group-er to include these codes in the case mix system, and issue a correction for OASIS records with a date of Oct. 1, 2011 and later.

The new dementia codes are included in the Psych 2 case mix category.

• Intrapelvic protrusion: CMS has re-moved 718.60 (Unpecified intrapelvic protrusion of acetabulum, site unspecified) from the case mix list, Selman-Holman points out. But don't worry about this change; it shouldn't actually affect home health agency reimbursement. This code was added to the case mix list in error long ago and really shouldn't have been used.

Why? The only acceptable fifth digit for 718.60 is "5" indicating "pelvic region and thigh," so a fifth digit of "0" for site unspecified is unacceptable, Selman-Holman says. The acetabulum is the socket for the head of the femur forming the hip joint.