OASIS Alert

Published on Thu Jan 03, 2013 PDF

Don’t let this assumption do a number on your reimbursement.

While you can no longer report resolved conditions in M1024 -- Payment diagnoses, you may be missing some opportunities to earn other case mix points. Try this expert advice to help cushion the blow of these changes.

1. Don’t assume a condition is resolved. There are times that coders may lose case mix points out of habit, Mary Deakle, HCS-D, COS-C, manager of compliance and education with Daymarck Home Healthcare Coding in Bismarck, N.D. cautions.

For example: If your patient has cancer and it’s not documented as resolved, you can still code for it as current in many cases, Deakle says. "If the patient had a mastectomy due to breast cancer, don’t assume it’s gone and that you could only have put the cancer in M1024 as a resolved condition," she says. The patient may be recovering from surgery before going on to receive chemotherapy. "Only listing the cancer in M1024 is a habit many coders have when the diagnosis may still count as active."

2. Beef up your understanding of disease processes. Make sure you know when a diagnosis is still active and when it’s been resolved.

For example: Spinal stenosis and spondylosis aren’t necessarily resolved by surgery, Deakle says. "When you have arthritis in your back, the only way to completely resolve the condition is to remove the bone," she says.

To make sure you’re not leaving case mix points on the table, study the disease process and treatments, Deakle advises. Know which treatments actually resolve the condition and which help alleviate symptoms.