OASIS Alert

Published on Mon May 28, 2007 PDF

Home health coding is about to get much more complicated.

If your agency doesn't have a coding professional, you may soon need one.

Old way: Before Oct. 1. 2003, the home health prospective payment system required clinicians to figure out how to select a primary diagnosis without using V codes. After that date they had to learn how to use V codes without forgetting the numeric coding they would have used before CMS allowed V codes.

New way: Now the proposed PPS update will ask clinicians and coders to continue that process, apply it to secondary diagnoses and learn a vastly expanded list of case mix diagnoses.

The expanded case mix diagnoses CMS proposes actually reflect the more common home health coding diagnoses, such as congestive heart failure, osteoarthritis and chronic obstructive pulmonary disease, says clinical consultant Judy Adams with Charlotte, NC-based LarsonAllen. "This change may give impetus to more accurate completion of M0230 and M0240," she predicts.

Take time to comment: "If you don't take time to submit comments, you lose your chance to effect changes in these proposed rules," Adams stresses.

For example, agencies should carefully review the changes in case mix calculations, Adams suggests. Do the diagnoses and conditions make sense for home care?

What do you think about the points toward the case mix and how those points change based on an early or later episode?

Do this:  Look at your agency's data and see if proposed changes such as paying more in third and later episodes and less in first and second episodes make sense, Adams advises.

The proposed changes also leave out an important case mix code, 434.91 (Cerebral artery occlusion, unspecified, with cerebral infarction), says coding consultant Lisa Selman-Holman of Denton, TX-based Selman-Holman & Associates. Instead, CMS includes the old code for a stroke, 436, which was changed as of Oct. 1, 2004 to no longer include cerebrovascular accidents, she tells Eli.

Note: For more details about the proposed changes to diagnosis coding, order Eli's Home Health ICD-9 Alert at www.elihealth.com or by calling (800) 874-9180.