Home Health ICD-9/ICD-10 Alert

Watch for additions to heart and mental conditions case mix diagnoses.

Brace yourself for upcoming case mix changes, thanks to the proposed rule on the prospective payment system released April 27.

Good news: The Centers for Medicare & Medicaid Services addressed many of the industry's concerns with the proposed changes, notes Bob Wardwell with the Visiting Nurse Associations of America. The rule proposes action on significant changes in condition (SCICs), the therapy threshold, low utilization payment adjustments (LUPAs), M0175, uneven allocation of payment to key home health resource groups (HHRGs), non-routine medical supplies and long-stay patients, points out Wardwell, who headed up PPS' creation and implementation when he was a top official at CMS.

Check Out These Case Mix Alterations

CMS made sweeping changes to how it will determine and structure the payment categories, resulting in a proposed increase from the current 80 HHRGs to 153 categories.

New case mix diagnoses: CMS proposes adding new diagnosis groups, comorbidities and interactions to the list of case mix diagnosis codes. For example, some heart and mental conditions will gain case-mix scores as will wound-related diagnosis codes beyond those in the current HH PPS case-mix model. Certain secondary diagnoses, such as secondary cancer diagnoses, will also earn scores.

CMS wants to add OASIS items M0470 on stasis ulcers, M0520 on incontinence, M0610 on cognitive/neuro/emotional behaviors and M0800 on injectable medications.

Name change: The case-mix categories will also receive a makeover. CMS proposes eliminating the "0" category for the clinical, functional and service domains in the HHRGs. Instead, the groups will start with "1"s, so C1F1S1 would be the lowest-severity category.

Watch for more on how these changes will impact your coding in the next issue of Home Health ICD-9 Alert. For more details on the PPS changes, see Eli's Home Care Week.