Home Health ICD-9/ICD-10 Alert

Proper sequencing can boost your reimbursement.

If you're confused about how to calculate non routine supply (NRS) points, you're not alone. Use this handy tool to determine which diagnoses impact NRS to be sure you're getting the full reimbursement you're rightly due.

Tracking how case mix points are earned has grown increasingly complex. One area to undergo significant change is calculating case mix points for non routine supplies (NRS). Seven case mix categories offer non routine supply points, says Tricia A. Twombly, BSN, RN, HCS-D, CHCE senior education consultant and director of coding with Foundation Management Services in Denton, Texas. And four of these seven involve wounds.

Coding scenario: Your patient was admitted for your care of an abdominal surgical wound that dehisced. He also has an infected second degree burn to the hand from scalding water. Both wounds will require equal attention from the nurse. How would you code for this patient?

Because both of the patient's wounds require the same amount of care, the order in which you sequence them is discretionary, Twombly says. Considering how NRS points are awarded may impact your sequencing.

For example, you could list the codes in the following order:

• M1020a: 944.20 (Blisters, epidermal loss [second degree]; hand, unspecified site);

• M1022b: 998.32 (Disruption of external operation [surgical] wound); and

• M1022c: E924.0 (Accident caused by hot liquids and vapors, including steam).

Sequencing the codes in this order would earn your agency ten clinical points for a low therapy episode or 20 clinical points for high therapy, Twombly says. You would also earn 19 NRS points.

However, if you listed 998.32 first, followed by 944.20, your potential clinical points would remain the same, but you would earn 23 NRS points, making this the better sequencing option.

To make tracking case mix categories that offer NRS points easier, refer to the following chart.

• 250.8x (Diabetes with other specified manifestations) if reported as the principal diagnosis in M1020 and immediately followed with diabetic ulcer 707.1x (Chronic ulcer of skin) earns 20 NRS points.

• 249.8x (Secondary diabetes mellitus with other specified manifestations) reported as the principal diagnosis M1020 and followed with diabetic ulcer 707.1x (Chronic ulcer of skin) earns 20 NRS points.

The following diagnoses earn 19-23 NRS points when reported as the principal diagnosis in M1020 or 8-15 NRS points when reported as the secondary diagnosis in M1022:

• Trauma/open wounds

• Traumatic amputations

• Burns

• Complicated surgical wounds including dehiscence, infection, non-healing, and persistent fistula.

• 897.x (Traumatic amputation of leg[s] [complete] [partial]) earns 19 NRS points when reported in M1020 as the principal diagnosis or 8 NRS points when reported as a secondary diagnosis in M1022.Note: Most amputations are not traumatic.

The following diagnoses earn 11-20 NRS points when reported in M1020 as the principal diagnosis or 8-13 NRS points when reported as a secondary diagnosis in M1022:

• Abscess

• Cellulitis

• Gangrene

• Ulcers.