Home Health Coding and OASIS Expert

Consider a referral for PT or OT evaluation.

Background: The Centers for Medicare & Medicaid Services is giving extra scrutiny to claims for insulin injections following a 2013 report from the HHS Office of Inspector General. The OIG found fraud and abuse problems related to claims containing diabetes diagnoses and outlier payments for insulin injections.

The OIG’s report concluded that some home health claims for insulin injections were unnecessary because the patient was physically and mentally able to self-inject.

Try this: A thorough, documented assessment can back up the need for your patient to receive skilled visits for insulin injection. But before a skilled nurse assesses for ability, you may want to consider a referral for an occupational therapy or physical therapy evaluation, says Judy Adams, RN, BSN, HCS-D, HCS-O, with Adams Home Care Consulting in Asheville, N.C. “These disciplines have access to a large box of tools that they can use in assessing and treating patients in areas such as manual dexterity, vision, mobility and general activities of daily living,” she says.

Here is a list of some specific tools that can be used with diabetic patients:

Dexterity:

• Functional Dexterity Test
• Jebsen-Taylor Test of Hand Function
• Nine Hole Peg Test
• Purdue Pegboard Test
• Sequential OT Dexterity Assessment
• Grooved Pegboard Test (dexterity and visual acuity)

Cognitive Status:

• Mini-mental State Exam
• Mini Cog or Sweet 16 Test
• Informant Questionnaire on Cognitive Decline in the Elderly
• Nurses’ Observation Scale for Cognitive Abilities

Functional Assessment:

• Minnesota Rate of Manipulation
• O’Connor Dexterity Tests
• Jebsen-Taylor Hand Function Test

Strength:

• Hand Grip Strength Test
• Pinch Test

Activities of Daily Living:

• Katz Index of Activities of Daily Living also known as Katz ADL

In addition to documenting the patient’s cognitive and functional assessments, ensure that you verify those issues found with the physician and code for them as part of the OASIS, POC, and claim. Medicare has provided a proposed list of diagnoses that you may use to substantiate the need for the nurse to inject the insulin and include on these patients’ claims, Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, HCS-O, consultant and principal of Selman-Holman & Associates, Code Pro University and CoDR — Coding Done Right in Denton, Texas.

Note: See Home Health Coding and OASIS Expert Vol. 12 No. 6 for more on this issue.