OASIS Alert

Q. Help! I'm getting conflicting instructions. When you admit a patient to home care for aftercare following a fracture, do you put the fracture code only in M0245 (if it's a case mix code replaced by a V code in M0230) or in both M0245 and M0240?

A. Unfortunately, it all depends. In the situation you describe, the case mix code should appear in M0245, advises Sue Bowman, director of coding policy and compliance for the American Health Information Management Association in Chicago. M0230 and M0240 must adhere to the official guidelines for primary and secondary diagnoses, she explains. "These guidelines stipulate that the fracture code may not be used for any encounter subsequent to the initial fracture treatment," Bowman says.

This prevents the fracture from being counted twice, explains consultant Pat Sevast with American Express Tax and Business Sevices in Timonium, MD. Since M0245 does not transfer to the claim form, the fracture code can be used there. And fracture codes are put in M0245 for many fractures. Lower extremity fracures may show "gait abnormality" in M0245, since thats the focus of therapy, she adds.

For home health coding purposes, the fracture no longer exists, since that diagnosis is no longer active, says Linda Dilts-Benson with Reingruber & Co. in St. Petersburg, FL. But the code placed in M0245 may also be in M0240. For example, if the case mix code that belongs in M0245(a) is abnormality of gait, that code may also need to be in M0240 so the diagnosis can be "pulled through to the 485," she says.

One reason for conflicting information may be an agency's software, says Chapel Hill, NC-based clinical consultant Judy Adams with the LarsonAllen Health Care Group. Because the Centers for Medicare & Medicaid Services wants any diagnosis important enough to be a case mix diagnosis also to appear on the plan of care, how your software transfers information from the OASIS to the POC is important.

If the software doesn't transfer M0245 to the POC, some agencies repeat that diagnosis in M0240 so it will be transferred, Adams explains. Other software programs transfer M0245 to the POC and don't allow any duplicate diagnoses, so you would need to be sure not to duplicate the M0245 code in M0240 with this type of program, she says. On the other hand, some software requires a code in M0245 even if there is no V code in M0230 displacing a case mix code, she adds.