Inpatient Facility Coding & Compliance Alert

Question: I’m shifting from our inpatient coding to reporting the hospital’s home care services. What kinds of differences should I expect to find when coding for a patient who moves from the hospital to home care?

New Jersey Subscriber

Answer:  One of the most important issues is knowing how to handle physical conditions for which the patient underwent treatment in the hospital.

Example: Many people assume a condition is resolved because the patient left the hospital or because he had surgery. That leads to the assumption that you can’t report the condition as a primary or secondary diagnosis in home care because it is an “acute condition.” Remember, however, that just because the patient was placed in a wheelchair and wheeled out of the hospital doesn’t mean all the conditions were resolved.

Many conditions that are considered acute can still be coded as current conditions in home care. Take a closer look at the following conditions before assuming they are resolved:

·         Sepsis sometimes continues to be treated at home but many coders think they cannot code sepsis in home care. This is a myth.

·         Myocardial infarctions should be coded as acute for eight weeks.

·         Venous thrombosis and pulmonary embolism should be coded as acute unless the physician states the condition is chronic. These conditions are considered acute for 3-6 months after they occur.

·         Neoplasms are not necessarily resolved after surgery, but some coders treat the cancer as a resolved condition. The default action is to code the neoplasm as current unless you have documentation to prove that the history code is more appropriate.

·         Malignant hypertension is not very common, and is often confused with hypertensive crisis. If the physician documents in the hospital record that the patient has malignant hypertension, then you should code for it as malignant hypertension. When a physician documents “malignant hypertension” or “accelerated hypertension,” it means that there is target organ damage caused by the hypertension. Code for malignant or accelerated hypertension with fourth digit “0,” such as with 401.0 (Essential hypertension; malignant).

Bottom line: Very few diagnosis codes are off-limits for home care, Think twice if someone tells them you cannot code acute conditions in home care.