Home Health Coding and OASIS Expert

Published on Fri Jun 12, 2015 PDF

You’re bound to get confused about which form to use and which code set to report when the crunch is on for ICD-10 and OASIS-C1/ICD-10. Try these strategies from Lisa Selman-Holman, JD, BSN, RN, COS-C, HCS-D, HCS-O, AHIMA Approved ICD-10-CM Trainer/Ambassador of Selman-Holman & Associates, LLC, CoDR — Coding Done Right and Code Pro University in Denton, Texas to help smooth the way.

Assessments beginning Aug. 3

For episodes beginning Aug. 3 and ending Oct. 1, you’ll use the OASIS-C1/ICD-9. You’ll report ICD-9 codes on the RAP and ICD-10 codes on the claim, Selman-Holman says. To make it easier to complete the claim, consider listing the ICD-10 codes in plan of care item 21 or elsewhere so you can retrieve them at the appropriate time.

This applies for episodes beginning Aug. 3 through Sept. 24, Selman-Holman says. This includes start of care (SOC), recertifications and ROCs acting as recertifications.

SOC at end of September

The M0090 date determines which OASIS you will complete. You have five days after the SOC to complete the OASIS.

For example: SOC is Sept. 28 but the assessment is completed Oct. 2 because the patient had a pressure ulcer covered by a non-removable dressing that the clinician wanted to assess. In this situation, you would complete the OASIS-C1/ICD-10 using ICD-10 codes that will determine the HIPPS code, Selman-Holman says. But you’ll code the RAP with a ‘from’ date of Sept. 28 in ICD-9.

Strategy: In this situation, if possible, try to finish SOC by Sept. 30, so you can use the OASIS-C/ICD-9 and ICD-9 codes for this patient, Selman-Holman suggests. Or go ahead with the OASIS-C1/ICD-10 and figure out what ICD-9 codes you’ll need for the RAP.

Recertification at end of September

You must complete the OASIS within five days before the ‘from’ date on a recertification, Selman-Holman says. So, a recertification episode starting on Oct. 2 could have a M0090 date of Sept. 28.

In this situation, you’ll use ICD-9 codes on the OASIS-C1/ICD-9 and ICD-10 codes on the RAP and claim.

Strategy: If possible, don’t do the recert assessment until Oct. 1, Selman-Holman suggests. Then you can use the OASIS-C1/ICD-10 and ICD-10 codes and you won’t have to re-code.

Resumption of Care at end of September

For ROC at the end of September, you’ll base your OASIS and code set selection on the M0090 date on the assessment. You have two days after discharge (or after knowledge of discharge) to complete the ROC assessment. Remember, a visit can be made prior to the ROC assessment, Selman-Holman says.

For example: Your patient comes home from the hospital on Mon. Sept. 29. A Licensed Vocational Nurse makes a visit on Tues. Sept. 30. The RN completes ROC assessment on Wed. Oct. 1.

Strategy: If you complete the OASIS-C1/ICD-10 in October, you can use ICD-10 codes, Selman-Holman says. That means your coding is already mostly done for the final claim.