OASIS Alert

Published on Tue Jul 01, 2003 PDF

Follow these 5 tips to safeguard your reimbursement

If you're facing a pile of returned claims, you may not understand the 2002 coding changes. Even after half a year of using the coding changes initiated Oct. 1, 2002, providers will find some clarifications helpful, instructed Prinny Rose Abraham, a coding expert with Minneapolis-based HIQM Consulting, in a May 22 Eli Coding Institute teleconference. She offered these tips:

1. Note the change in reporting congestive heart failure. Payors' interest in differentiating between systolic and diastolic heart failure resulted in this change. Use codes in the 402 and 404 series to report the hypertensive heart disease, with the fifth digit specifying "with heart failure." Follow with 428 to describe the type of heart failure, Abraham said.

2. Keep "crib sheets" current. If you're seeing coding for disruption of surgical wounds returned to provider, you're probably missing the last digit. Code 998.3 now requires a fifth digit of 1 for disrupted internal sutures and 2 for disrupted external sutures. Check to be sure clinicians using "cheat sheets" of frequently used codes have updated these for coding changes, she urged.

3. A fifth digit is required for late effects of cerebrovascular accident. New codes include 438.83 (facial weakness), 438.84 (ataxia) and 438.85 (vertigo). The sequence would be the residual condition - late-effect manifestation - code first and the cause code second.

4. Understand Chapter 17 symptom codes.Don't confuse these with late effect CVA codes, Abraham warned. The symptom codes include 780.4 (dizziness and giddiness), 781.3 (lack of coordination) and 782.0 (disturbances of skin sensation). "If you're not sure the symptom is a late effect of a CVA, coding guidelines say you need to default to a symptom code," she advised.

5. Have a "go to" person in your agency. Prevent problems by designating someone who knows how to do the research on how to use the new codes, Abraham said.