Home Health ICD-9/ICD-10 Alert

Question: Our OASIS data collection software auto-populates or forces certain diagnosis codes in some circumstances. Sometimes I worry that what we report as a result isn’t accurate. What should we do?

Wisconsin Subscriber

Answer: OASIS data collection software is no replacement for the skills of a trained home care coder.

Some software is built with "cheat sheet"-like logic which causes it to take short-cuts like automatically populating a fifth digit. While these software techniques may save you time, they won’t increase accuracy.

And when your OASIS data is inaccurate, not only are you setting yourself up for incorrect claims, your inaccurate codes will impact overall home care data. Remember, CMS uses this data to adjust the home health prospective payment system, and it’s also used to tabulate health care statistics.

When it comes to choosing an OASIS software vendor, if you have an opportunity to be part of the process, be sure to take it. And ask the software vendor to help you understand the logic that goes into the coding piece of its software.

If you find that your software is programmed to behave in a way that runs contrary to the coding guidelines or to CMS guidance, find that guidance in writing, and share it with your vendor.

Keep in mind: Vendors are often crunched for time in getting their programs ready during the short window of time between CMS’ announcement of the PPS revisions and the final implementation date on Jan. 1. It’s best to keep in mind the difficulty your vendor faces in updating the program. Be sure to take a positive approach when working with your vendor to fine-tune coding intricacies.

Bottom line: Nothing replaces checking your ICD-9 coding manual for the correct codes. An expert coder should always review diagnosis codes to verify that they are correct and at the highest level of specificity before a patient record is locked and transmitted.