Home Health Coding and OASIS Expert

As a clinician, how do you determine the primary and secondary diagnoses? Make certain you’re not looking in the wrong place for sequencing guidance.

Caution: Don’t rely on the discharge summary for guidance on selecting and sequencing diagnoses, warns Beth Johnson, MBA, BSN, RN, CRRN, HCS-D, HCS-O, President of Johnson, Richards & Associates, in Brighton, Mich. “There’s no rhyme or reason to how the diagnoses are listed there.”

Instead, look to your assessment findings, information in the medical record, and input from the physician, the Centers for Medicare & Medicaid Services advises in the OASIS Guidance Manual.

Once you’ve reviewed these resources, it’s time to determine which diagnoses to list on the OASIS and how to sequence them. Consider these steps from Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, HCS-O, consultant and principal of Selman-Holman & Associates and CoDR — Coding Done Right in Denton, Texas as you analyze your diagnoses for sequencing.

1. Determine the diagnosis that is the chief reason for home care. This may not be the primary inpatient diagnosis.

2. Consider and apply any sequencing rules that may be applicable to the condition you have determined is the principal reason for home care.

3. Assess which other diagnoses will most impact the healing or recovery of the primary diagnosis. Also review diagnoses that will require active intervention.

4. Take into account any other diagnoses that will impact the care you provide even if they won’t require interventions.

5. Think about any V codes that could further describe the care you will provide.