Home Health ICD-9/ICD-10 Alert

Don't let code changes fall through the cracks.

The OASIS, CMS 485 and the UB-92 make for a virtual mountain of paperwork for each patient in your home health agency - and that makes ensuring all the ICD-9 codes match across forms a major challenge. Here's how one agency keeps everything straight.

The first step at Alacare Home Health & Hospice in Birmingham, AL is for the nurse to enter her ICD-9 codes into the computer system's customer maintenance screen, says OASIS and coding coordinator Margaret Rush, RHIA, HCS-D. Those codes then flow over to OASIS items M0230 and M0240 before the agency submits the assessment. Likewise, the UB-92 pulls the ICD-9 codes from customer maintenance, as well as M0245a and M0245b on the OASIS where applicable, she explains.

Thus, all the codes should automatically match from the beginning - and it's essential that they're all correct. To ensure accuracy, an outcome specialist manager reviews the nurse's work and requests corrections as needed, Rush tells Eli.

Automatic messages help: Alacare staffers know right away if the ICD-9 codes on the OASIS, UB-92 and 485 don't match. When they try to lock documents with mismatched codes, an error message pops up that identifies the problem, Rush explains.

When this happens, the nurse will simply correct the OASIS, which flows back to the customer maintenance screen. Then, the 485 is refreshed if necessary, she says.

"If the nurse does not make the correction and locks the documents, the error is identified when billing staff sends a request for anticipated payment [RAP], or when I discover the error in audits," Rush reports.

When someone uncovers an error, that person will notify the nurse of the mismatched codes. The nurse will then let the OASIS coordinator know to unlock the documents so the nurse can correct the mistake and annotate the OASIS accordingly.