Home Health ICD-9/ICD-10 Alert

Question: I am pulling my hair out over the comorbidity documentation/secondary coding. I have been told that co-morbidities should be addressed on the plan of care in order to be coded. The problem is I can't find the official resource so I feel a little off my mark. Can you please guide me to the resource?

Answer: Official resources you can turn to include the guidance in Chapter 8 of the OASIS Implementation Manual at M0230/M0240/M0246 and attachment D. Ongoing discussion with the Centers for Medicare & Medicaid Services (CMS) regarding its expectations continues. One recent email from CMS indicates that if a diagnosis code is listed it should be at least mentioned in the POC, so this may be a good rule of thumb to follow. Chapter 8 defines secondary diagnoses in as "all conditions that coexisted at the time the plan of care was established, or which developed subsequently, or affect the treatment or care." When listing a diagnoses in M0240, you should include conditions actively addressed in the patient's plan of care as well as any co-morbidity affecting the patient's responsiveness to treatment and rehabilitative prognosis, even if the condition is not the focus of any home health treatment itself, CMS advises. Avoid listing diagnoses that are only of historical interest and don't impact patient progress or outcome.

Attachment D includes the following guidance regarding reporting co-morbidities: "Secondary diagnoses, or other diagnoses, are defined as all conditions that coexisted with the primary diagnosis at the time the plan of care was established, or which developed subsequently, and that affect the treatment or care."

When considering which secondary diagnoses meet the requirements for reporting, attachment D advises you to do the following:

• Make sure that the diagnosis is addressed in the home health plan of care and that it affects the patient's responsiveness to treatment and rehabilitative prognosis.

• Check that the secondary diagnoses reported on the OASIS are sequenced to best reflect the seriousness of the patient's condition and to justify the disciplines and services provided.

• In cases where the secondary diagnosis assigned to M0240 is a V code, consider whether it's appropriate to report the numeric diagnosis that the V code is replacing.

• In a mandatory multiple coding situation (such as an etiology/manifestation pair), list both codes in M0240. List the etiology code first, followed by the manifestation code.