Eli's Hospice Insider

Hospice diagnosis coding changes will hit hard, report indicates.

Don’t be surprised to see Medicare focusing on neuro diagnoses, general inpatient care, and beneficiaries who revoke the hospice benefit.

Statistics from a new supplemental report from comparative billing report contractor SafeGuard Services show that underprovision of GIP may be a concern. When SGS examined claims for nearly 15,800 hospice beneficiaries who died in May 2013, “the majority of services were billed under the routine home care revenue code,” the CBR contractor says. “The next largest revenue code used was General Inpatient Care at only 1.95 percent of all revenue codes used.”

And the ban on using failure to thrive and debility as primary diagnoses on hospice claims will mean big coding changes for many hospices when it hits next fall, the report indicates. Debility (799.3) was the most common diagnosis code on the claims at 12.7 percent, the report reveals. And adult failure to thrive (783.7) was the sixth-most common code at 7.4 percent.

Many hospices also will be subject to the scrutiny that the Centers for Medicare & Medicaid Services has promised for non-specific dementia codes (see related story, p. 89). Five dementia codes combined (290.0, 290.4, 294.10, 294.11, 294.2) ranked third-most common at 12.1 percent and Alzheimer’s (331.0) was seventh at 5.4 percent.

“Length of stay has increased significantly driven by the increase in neurological diagnoses such as Alzheimer’s and dementia as well as poorly specified diagnoses — adult failure to thrive and debility,” SGS notes in the report.

Turnover: One fifth of hospices active in 1999 had closed by 2009, SGS points out in the report. Ownership type also shifted from non-profit to for profit, with four of five new hospice agencies between 2000 and 2009 being for profit. “Hospice agencies became larger and the number of agencies increased in all regions of the country with larger growth in the south and west,” SGS continues. “In short, this sector has witnessed considerable overturn in the past decade.”

Note: More stats and benchmarks are in the report online at www.safeguard-servicesllc.com/cbr/documents/HospicesupplementalretrospectivecohortCMS.pdf.