OASIS Alert

Some primary diagnoses are suspect after the initial episode.

Diagnosis coding errors are coming back to haunt agencies.

Regional home health intermediary Cahaba GBA has expanded its focus on the accuracy of specific OASIS diagnosis codes in M0230 (see OASIS Alert, Vol. 6, No. 11). In probe reviews of the codes listed below, the RHHI found error rates ranging from a low of 29 percent for a primary diagnosis of muscle wasting or unspecified muscle disorder to a high of 73 percent for a primary diagnosis of schizophrenia.

Heads up: In addition to scrutiny for claims with a primary diagnosis of V58.3 (Attention to surgical dressings and sutures), Cahaba has announced widespread probes for claims with the following diagnoses codes as primary:

--331.0 (Alzheimer's disease) with length of stay greater than 60 days.
--332.x (Parkinson's disease) with length of stay greater than 60 days, without any billed therapies.
--295.xx (Schizophrenic disorder) with length of stay greater than 60 days.
--728.2 (Muscle wasting and disuse atrophy, NEC) or 728.9 (Unspecified disorder of muscle, ligament and fascia).
--496 (Chronic airway obstruction) length of stay greater than 120 days.
--332.x (Parkinson's disease) that meet the 10-visit therapy threshold.
--Claims with revenue code 042X that meet the therapy threshold and have a length of stay between 61 and 120 days.

Note: More information about these probes is at www.iamedicare.com/Provider/newsroom/whatsnew/whatsnew.htm. For a more detailed discussion of coding issues, order Eli's Home Health ICD-9 Alert at www.elihealthcare.com or by calling 1-800-874-9180.

• The Centers for Medicare & Medicaid Services has added a new 2006 OASIS Follow Up Assessment Calendar at www.qtso.com/hhadownload.html, to assist agencies in scheduling recertification visits.
 
Note: To receive a copy of the new 2006 OASIS Follow Up Assessment Calendar in pdf format, email OASIS Alert Editor Marian Cannell at marianc@eliresearch.com with "Assessment Calendar" in the subject line.

• CMS issued the new home health episode base rate of $2,327.68--a 2.8 percent increase over 2005 rates, according to the 2006 PPS update final rule. New per-visit rates by discipline are also included at www.cms.hhs.gov/providers/hha/cms-1301f.pdf. Like last year, the new rates will take effect on Jan.1, CMS instructs.
 
• Medicare's free HAVEN software now reflects the new diagnosis codes that took effect Oct. 1. HHAs can download a new code database for HAVEN, which transmits OASIS data, at www.cms.hhs.gov/oasis/hhnew.asp.