OASIS Alert

Welcome improved dementia reporting.

If you thought you'd have minimal 2012 ICD-9 updates to remember when completing M1020/M1022/M1024 because of the focus on transitioning to ICD-10 in 2013, you're in for a surprise. As of Oct. 1, you'll have more changes than in previous years: 166 new codes to grapple with, along with 168 revisions and 88 deletions.

"There are a lot of changes for this last year of regular updates to ICD-9-CM," says Judy Adams, RN, BSN, HCS-D, COS-C with Adams Home Care Consulting in Chapel Hill, N.C.

Fast track: Many of the new codes were first introduced at the March 2011 ICD-9 Coordination and Maintenance Committee meeting, says attendee Therese Rode, RHIT senior coding manager with Inova VNA Home Health in Falls Church, Va. While code suggestions can often take years to become reality, the speedy approval cycle this year is likely due to the plan for limited changes next year as the implementation date for ICD-10 draws nearer, she says.

Neoplasm of the skin: There are 40 new five-digit codes in category 173.x (Other and unspecified malignant neoplasm of the skin). These new codes specify particular sites such as lip, eyelid, ear, other parts of face, scalp and skin of neck, trunk, upper limb, lower limb, other specific sited of skin, and skin, site unspecified, Adams says.

The new fifth digits differentiate between basal cell carcinoma and squamous cell carcinomas of the skin. These same differentiations are found in ICD-10.

Category 173 is a case mix diagnosis in the Neoplasm category, but CMS only included ten of the new codes in the July 2011 PPS grouper update. The included codes all list fifth digit "9," meaning "other specified," which means there would be no case mix points for skin cancer other than melanoma (coded with 172 codes, already case mix codes), points out Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates and CoDR -- Coding Done Right in Denton, Texas. "Fifth digit '0' means unspecified so if the physician documentation says simply 'skin cancer,' there would be no case mix points," she says.

In addition, if the physician specified basal cell skin cancer or squamous cell skin cancer, there also would be no points, Selman-Holman says. "CMS's choice to include fifth digit '9' is a major problem because that '9' means only 'other specified' skin cancers are included as case mix," she says. "If you search for non-melanoma skin cancers, the only types mentioned are basal cell and squamous cell, so CMS has effectively deleted a case mix code without regulatory change." Stay tuned to see if CMS makes a change to correct this.

Thalassemia: There are six new five-digit codes for specific forms of thalassemia replacing current code 282.49 (Other thalassemia). Five of these more specific codes will be case mix diagnoses. But, while category 282 (Hereditary hemolytic anemias) is already in the Blood Disorder case mix category, 282.40 Thalassemia, unspecified was not included in CMS's grouper update as a case mix code.

However, the number of patients with these conditions seen in home health is likely to be limited, she says. Thalassemia is a rare condition passed down through families resulting in destruction of red blood cells.

Pancytopenia: Three more specific five-digit codes related to pancytopenia at 284.1x (Pancytopenia) have been added to case mix since category 284 in the Blood Disorder category.

Dementia: New codes 294.20 (Dementia, unspecified, without behavioral disturbance) and 294.21 (Dementia, unspecified, with behavioral disturbance) are a welcome addition because they allow home health coders to report dementia not related to another disease process like Alzheimer's, says Jennifer Warfield, BSN, HCS-D, COSC, education director with PPS Plus Software in Biloxi, Miss. These new codes also allow you to differentiate whether the patient exhibits behavioral disturbances, Warfield says. These codes will replace 294.8 (Dementia NOS).

Another change to the dementia codes is the addition of the underlying disease of Parkinson's to the 294.1x (Dementia in conditions classified elsewhere) subcategory and the removal of wandering from the code. New code V40.31 (Wandering in diseases classified elsewhere) indicates wandering for those with dementia and it is a new "use additional code" note at 294.11 (Dementia in conditions classified elsewhere with behavioral disturbance) and 294.21 (Dementia, unspecified, with behavioral disturbance), says Selman-Holman.

Another case mix disappointment: The 2011 code for dementia, NOS is 294.8 and is a case mix code. Deleting the inclusion note for Dementia, NOS from 294.8 and moving it to 294.2x seemed like a welcome change, but the 294.2x codes are not on the case mix list, "So once again CMS has deleted a case mix code," Selman-Holman says.

Fractures: Two new codes, 808.44 (Multiple closed pelvic fractures without disruption of pelvic circle) and 808.54 (Multiple open pelvic fractures without disruption of pelvic circle) along with revised codes 808.43 (Multiple closed pelvic fractures with disruption of pelvic circle) and 808.53 (Multiple open pelvic fractures with disruption of pelvic circle) will be case mix diagnoses in the Ortho 1 category since all of the 808 (Fracture of pelvis) category is case mix, Adams says.

The pelvic fracture codes were catch-alls previously, Warfield says. The new codes add specificity and allow you to indicate whether the fracture involves the disruption of the pelvic ring.

Another improvement that these codes bring about is to allow you to list one single code when the patient has multiple pelvic fractures, Rode says.

Editors note: That's not all! We've covered the changes to the case mix diagnosis list in this article, but there are still many other new codes that will impact home health. Watch for more articles on the changes, including an article discussing changes to how you'll code memory disturbance, bladder disorders, and complications as well as the new V codes you'll soon have available, in upcoming issues of Eli's OASIS Alert.