Home Health Coding and OASIS Expert

Question: I have a question about OASIS item M1023 — Other diagnoses. I know it’s appropriate to list diagnoses for which we are providing home health treatment in this item, but are we also able to include diagnoses that will affect the patient’s rehabilitative prognosis and responsiveness to treatment, even if we aren’t directly treating those conditions?

West Virginia Subscriber

Answer: As the assessing clinician, consider both the diagnoses that are listed in the Plan of Care and those that could impact the patient’s responsiveness to treatment and rehabilitative prognosis when deciding which of the patient’s diagnoses you should list in M1023. Even if the diagnosis isn’t the focus of any home health treatment, if it will affect the patient’s progress, it’s appropriate to list in in M1023, according to the July 2015 Quarterly Q&As from the Centers for Medicare and Medicaid Services (CMS).

The ICD-10-CM Official Guidelines for Coding and Reporting explain that “other diagnoses” means “additional conditions that affect patient care in terms of requiring:

clinical evaluation; or

therapeutic treatment; or

diagnostic procedures; or

extended length of hospital stay; or

increased nursing care and/or monitoring.”

The coding guidelines go on to refer to the Uniform Hospital Discharge Data Set (UHDDS) which defines other diagnoses as “all conditions that coexist at the time of admission, that develop subsequently, or that affect the treatment received and/or the length of stay. Diagnoses that relate to an earlier episode which have no bearing on the current hospital stay are to be excluded.”

Since the July 31, 1985 publication of the UHDDS in the Federal Register, application of these definitions “has been expanded to include all non-outpatient settings (acute care, short term, long term care and psychiatric hospitals; home health agencies; rehab facilities; nursing homes, etc.),” the guidelines say.