Don’t get sidetracked by other codes

Editor’s note: Today’s post concludes our four-part series on common home health coding errors. If you’d like to receive more home health coding tips in your Inbox each week, sign up for our free email, The Monday Fix.

Seeing existing codes in a patient’s medical record can sometimes be distracting to home health coders, particularly novice coders who don’t yet feel confident in their own judgment. It’s tempting to look at the codes someone else has assigned, and use those codes as a starting point.

coding errors blog post art smaller 1But those codes can be misleading — especially if they were assigned prior to the patient’s admittance to home health, during treatment in an inpatient facility, where the coding rules may be different.

Home health coders need to be wary of any previously assigned codes encountered in the medical record, focusing instead on assigning new codes directly from the M.D.’s written notes.

Codes from skilled nursing facilities, wound care centers or clinics may have little bearing on the home health episode. Coding guidelines for those facilities can sometimes differ in important ways from coding guidelines for home health — and in some cases, codes from facilities may not be specific enough.

As an example, if a patient with Type 2 diabetes and peripheral neuropathy has been referred to home health, the skilled nursing facility where the patient was treated may have selected E11.9 (Type 2 diabetes without complications) as the code. If documentation from the M.D. during the patient’s hospital stay establishes that the patient has peripheral neuropathy due to diabetes, E.11.9 would not be the correct code. The coder would need to select E11.42.

Written notes from the M.D. supercede any code selected by any facility. Keep your eyes on those written notes, coding only from what has been documented there, and it becomes easier to avoid a coding error.

This was the fourth in a series of blog posts about common coding errors. Did you miss any of these other posts?

Click here to read about coding an uncertain diagnosis.

Click here to read about coding signs and symptoms.

Click here to read about coding previously treated conditions.

Do you need ICD-10 training or review?
Home Health Solutions can help you develop your home health coding skills, whether you are just starting out or an experienced coder needing CEUs.
Our Absolute Beginner course guides you through the basics of ICD-10, while our Absolute Auditor workshops for intermediate level coders offer training in both ICD-10 and OASIS.
HHS is excited to announce that the May 17-20 session of Absolute Auditor in Bessemer, AL, will be available via Live Stream as well.
To register, click here.
To read details about our classes, click here.

Are you a member of our growing community of coders who subscribe to The Monday Fix, a free weekly email delivering home health coding tips to your Inbox? Click here to sign up.

 

History revisited: To code or not to code?

Editor’s Note: Today’s post is the third in a four-part series on common home health coding errors. The series concludes tomorrow.

Do you know when to code a patient’s previously treated conditions or history?

In many cases, a previous condition which has already been treated and resolved is not relevant to the current home health care treatment and will not need to be coded.

coding errors blog post art smaller 1A diagnosis of pneumonia from three months ago, for example, clearly has no impact on a current home health episode unless there are complications which are being addressed now.

But it isn’t always easy for inexperienced coders to discern “over and done” from the current focus of treatment.

A recent Code & Coffee Quiz (a coding contest and giveaway Home Health Solutions runs on its Facebook page on Mondays) illustrates how easy it can be to run upon this particular “pothole” in home health coding.

Here’s a look at the challenge:

coding challenge art for blog post

 Some less experienced coders might have been inclined, at least initially, to code the gangrene in the scenario described above. Why? Because the amputation was necessitated by a gangrenous ulcer. 

But home health isn’t dealing with this patient for gangrene; the gangrene was resolved when the below-the-knee amputation occurred, and the operative site is documented as “healing nicely.” Home health was ordered for this patient for post surgical assessment and physical therapy for gait.

Home health coders must remain focused first on the reason(s) the patient has been referred to home health, and only on a patient’s previous health history in light of its impact on current treatment. With the gangrenous foot removed, gangrene is no longer impacting this patient’s treatment.   

Sometimes, history does matter  

Sometimes, current care is impacted by the patient’s history or family history. If the history has a bearing on current treatment, some Z codes, in particular History Codes Z80-87, may be used as secondary codes.

Smoking history is one example of a way in which a patient’s history becomes relevant to a current episode of care, and you will likely need to code Z87.89, a history of nicotine dependence, for former smokers.

Some diagnoses, including HTN, MI, CAD, COPD and others, require using an additional code for a patient’s smoking status, history or exposure.

“When reviewing a chart for diagnosis coding, it is important to check the patient’s social history to note if they are an active smoker, or have a history of smoking, or exposure to tobacco smoke, maybe from a spouse who smokes,” says Holly Kolitz, QA manager and one of the team leaders at HHS. 

“Occupational exposure to environmental tobacco smoke is important to record, too. They may have worked in a bar for many years, for example.”

Be sure to visit the HHS blog again Thursday for the fourth in this series of blog posts about common home health coding errors. The HHS team will conclude the series with a post explaining why it’s so important not to become sidetracked by other codes. Did you miss the previous blog posts in this series?
Click here to read advice on coding a vague or uncertain diagnosis.
Click here to read advice on when to code signs and symptoms.

Do you need ICD-10 training or review?
Home Health Solutions can help you develop your home health coding skills, whether you are just starting out or an experienced coder needing CEUs.
Our Absolute Beginner course guides you through the basics of ICD-10, while our Absolute Auditor workshops for intermediate level coders offer training in both ICD-10 and OASIS.
HHS is excited to announce that the May 17-20 session of Absolute Auditor in Bessemer, AL, will be available via Live Stream as well.
To register for our classes, click here.
To read details about our classes, click here.

 

Are you a member of our growing community of coders who subscribe to The Monday Fix, a free weekly email delivering home health coding tips to your Inbox? Click here to sign up.

 

When to code signs and symptoms

Editor’s Note: Our four-part series on common home health coding errors continues today, with a look at when home health coders should include codes for signs and symptoms. 

In general, the home health coding rule for signs and symptoms is simple enough:

     Don’t code them if they are integral to the disease or condition with which the patient has been diagnosed; do code them if they are not.

Icoding errors blog post art smaller 1f an asthma patient experiences wheezing, for example, it’s a routine symptom of asthma and should not be coded along with the asthma. If a patient with myocardial infarction experiences chest pain, a symptom routinely associated with MI, coding the MI is enough. Home health coders don’t usually code signs and symptoms, relying instead on confirmed diagnoses: first, the primary diagnosis which is the reason for the encounter, and next all co-existing conditions which have been documented.

     However, there are some limited circumstances under which it may be acceptable to code signs and symptoms. Here are two of them:

 1. There is no specific diagnosis in the medical record. Since you always code to the highest degree of certainty, and there is no certain diagnosis, it may be acceptable to code certain signs and symptoms in lieu of a diagnosis.

      An example might be a patient who has been experiencing shortness of breath and swelling to the lower extremities. The physician has added Lasix to the medication regiment but states that the patient “might have CHF.”

     “In this case, the coder cannot code ‘might haves,’ so the only option left is to code the edema and shortness of breath, as these would be the focus of the home health episode,” says Heather Calhoun, Director of Special Appeals and Project Management at HHS.

     “If a definitive diagnosis cannot be obtained when querying the M.D., or the M.D. will not verify the CHF, that is all the coder is left to do.”

2. If there IS a diagnosis in the medical record, but documented signs and symptoms are NOT integral to or associated with the confirmed diagnosis, it is acceptable to code them.

      An example might be a patient with a diagnosis of CHF who has been seen by the physician after the family reports episodes of “short term memory loss.” If the memory loss is not related to any diagnosis in the M.D. documentation, the home health coder would use “memory loss” as one of the co-morbid diagnoses.

      Note that the “memory loss” would be important to report because it impacts the patient’s ability to improve, and to implement certain interventions in meeting goals.

      Determining whether signs and symptoms are routine manifestations of a disease or condition can sometimes be tricky for coders, and may require researching a disease or condition for clarification.

       When in doubt, online coding forums can be great places to seek the opinions of more experienced coders who are usually happy to share their insight, especially if you query rarely.

       Please note that forum courtesy dictates limiting the number of questions posed, and the frequency of questioning. Keep in mind that other coders are working on their own files, too, and taking time away from their work to answer. Coders who routinely ask for forum assistance with numerous cases often find the number of replies dwindling.

Be sure to visit the HHS blog again on Wednesday, when we’ll review another common home health coding error, discussing when it is appropriate to code a patient’s history. If you missed Monday’s post, click here to read our advice for coding a vague or uncertain diagnosis.

Do you need ICD-10 training or review?
Home Health Solutions can help you develop your home health coding skills, whether you are just starting out or an experienced coder needing CEUs.
The May 17-20 session of Absolute Auditor in Bessemer, AL, a suburb of Birmingham, will offer intermediate level ICD-10 and OASIS review. The workshop will be available via Live Stream as well.
For details on our classes, click here.

Are you a member of our growing community of coders who subscribe to The Monday Fix, a free weekly email delivering home health coding tips to your Inbox? Click here to sign up.

avoid icd potholes 3

 

Four home health coding errors to avoid

avoid icd potholes 3
Even proficient home health coders sometimes find themselves skidding into ICD-10-CM “potholes,” caught unaware by confusing or misleading circumstances.

The risk can be even greater for beginning or less experienced coders.

The Home Health Solutions team has identified four common trouble spots for inexperienced home health coders. Think of them as ICD-10 “potholes” that novice coders will need to take care to avoid.

We’re reviewing these trouble spots all week long on the blog, in posts specifically designed to help home health coders navigate issues such as handling a vague or uncertain diagnosis from the physician when to code signs and symptoms, when to code conditions that have previously been treated, and how to avoid getting sidetracked by codes from facilities where a patient may have been treated.

Today’s post looks at the uncertain diagnosis, and what home health coders should do if they run up against the lack of a definitive diagnosis in documentation from the physician.

Never code an uncertain diagnosis

Vague, uncertain diagnoses are the unicorns of home health coding. Even if you’re a believer, your coding won’t stand up to scrutiny without “proof” in the form of a specific, documented diagnosis.

Any diagnosis documented as “probable,” “suspected,” “questionable,”  or as “a working diagnosis” is, like the fabled unicorn, still a myth for home health coding purposes, and should never be coded.

This is true even if the physician has prescribed medication almost always prescribed for a particular condition or disease, and even if the patient is experiencing multiple symptoms associated with a  particular disease or condition.

Until or unless the physician documents a definitive diagnosis, it cannot be coded.

For coders transitioning to home health from some forms of inpatient coding, where signs and symptoms are coded, this can be an important change.

In many cases, querying the physician can solve the problem and obtain the necessary documentation. Sometimes, however, a physician isn’t ready or willing to make a definitive call.

Without a specific diagnosis, how should the primary reason for home health care be coded? Guidelines  instruct coders to code “to the highest degree of certainty.”  This means that under circumstances, when there is no specific diagnosis, you may be able to code specific signs and symptoms, abnormal lab results or other problems necessitating home health care.

If a patient has been admitted to home health with physician’s orders to monitor or treat specific symptoms, those symptoms are the focus of care, and may be coded in lieu of a definitive diagnosis.

Remember, however, that this is not the preferred solution, that it is best to query first, and that documentation from the physician regarding signs and symptoms will be required to establish the focus of care. In general, it is always preferable to code a specific diagnosis.

(Our four-part blog series on common coding errors continues Tuesday, when the HHS team will review some of the specific circumstances under which home health coders may be able to code signs and symptoms — and when to avoid coding them.)

Do you need ICD-10 training or review?

Home Health Solutions can help you develop your home health coding skills, whether you are just starting out or an experienced coder needing CEUs.
Our next session of Absolute Auditor, a training workshop for intermediate coders, will take place May 12-20 in Bessemer, AL, and will be available via Live Stream as well.
For details on our classes, click here.

Are you a member of our growing community of coders who subscribe to The Monday Fix, a free weekly email delivering home health coding tips to your Inbox? Click here to sign up.

 

OASIS-C2: Why your comments matter

oasis c2 changes on the horizon 2Editor’s Note: This article appeared in the April 18 issue of The Monday Fix, our weekly email delivering home health coding tips and news of interest to home health coders.

Feeling comfortable with ICD-10-CM yet?
We thought not.
You’re not sweating alone, though.  Assimilating some 68,000 codes is a huge undertaking, and even the “industry experts” are finding glitches, contradictions and confusing spots within this massive code set.
At last count, some 2,564 changes to the ICD-10-CM classification set are expected to be implemented Oct. 1: at least 1900 new codes, 351 revised codes and 313 deleted codes.
monday fix promo 6A few Excludes Notes will shift and others will disappear completely in this first reworking of the code set since its implementation at the first of 2016. Home health coders are awaiting the changes with a mix of curiosity, anticipation and a bit of apprehension.
Meanwhile, slightly less attention has been paid to some other significant changes coming at the first of 2017, although these changes could have a substantial impact on home health agencies.
The Outcome and Assessment Set generally known by its acronym, OASIS, is undergoing its own revisions, with new items, renumbered items, and some other changes in how data is collected.

WHY IT MATTERS

Why are these revisions so important to  home health care?

OASIS, implemented as part of the Improving Medicare Post-Acute Care Transformation Act generally known as IMPACT, has a huge impact on home health agencies in numerous areas.

The data from OASIS affects patient outcomes, STAR Ratings, reimbursement, and Value-Based Purchasing.

If an episode of home health care for a patient could be compared to a race to the finish line (quality outcome), collection of the OASIS data might be the pace car, going first to test track conditions, look for obstructions, set the pace and establish the positioning of all other cars.

“The data collection must be accurate and complete,” says Marti Holthus, a Quality Review Mentor on the Home Health Solutions team. “And it is so important, affecting so many aspects of home care, that the accuracy of clinicians completing the OASIS assessment has a direct bearing on the viability of an agency. ”

Proposed changes to OASIS for Jan. 1, 2017, are known as the OASIS-C2 data set. The Centers for Medicare and Medicaid Services has opened a public comment period to solicit input on OASIS-C2 from April 1 through May 31. In soliciting these comments, CMS hopes get a firmer idea about burden estimates from agencies affected. CMS is especially interested in suggestions for how to enhance the quality, utility and clarification of the information to be collected.

WHO SHOULD COMMENT?

” Everyone in the home health industry who will be looking at, completing, educating on, etc., should read the update and comment,” says Kimberly Searcy, Director of Global Education at HHS. “There are changes in wording, numbering, new items,  and these may impact agencies.”

An agency may determine, for example, that revisions will require additional monies for training, that additional time may be required to complete the OASIS, or that  reimbursement to the agency and publicly reported outcomes may be affected.

WHAT’S CHANGING

Specific OASIS C2 revisions include:

– 3 new standardized items (M1028, M1060, GG0170c)

– Renumbering of items (M1311, M1313, M2001, M2003, M2005)

– Consolidating checkboxes from multiple check boxes to a single box for data entry

– Changes the look-back period

– Changes the numbering system used for pressure ulcer staging from a Roman to Arabic numerals

HOW TO COMMENT

 Here is a link:

www.regulations.gov/#!documentDetail;=CMS-2016-0047-001

 In the SEARCH box at the top of the page, type OASIS-C2 to go to the appropriate menu.  Look for the Comment Now button and follow the prompts.

Would you like to subscribe to our free weekly email delivering home health coding tips and news of interest to home health coders? Click here to read more about The Monday Fix.

 

 

Home Health Solutions LLC announces acquisition

Even More Solutions 2

Home Health Solutions LLC has made a strategic move forward with the acquisition of Transitions Health and Wellness Solutions, an Ohio-based firm serving hospice and home health agencies.

In an announcement made public today,  HHS owner and President J’non Griffin described the acquisition as “another exciting milestone” in a year of significant expansion for the company she founded in 2012.

“Our mission is to provide the extensive resources, guidance, services and support home health and hospice agencies need to navigate the complexities of today’s fluid and challenging home health care market,” J’non said.

“With this acquisition, HHS is even better positioned to partner with agencies seeking clinical, operational and financial excellence, and we extend a warm welcome to all the Transitions clients who will now join the many agencies HHS is already serving. We are poised for additional growth, and remain committed to stay abreast of the many challenges in our field and provide the expertise our clients need.”

ABOUT TRANSITIONS

Transitions Health and Wellness, founded in 2010, is a North Canton, OH, company providing consulting, coding, chart auditing, training and education materials to home health and hospice agencies.

Former owner Brandi Whitemyer is a well-known industry authority with more than 14 years of direct experience in home health and hospice, and is a frequent contributor to Decision Health’s Diagnosis Coding Pro and other industry materials.

She is currently the active Product Specialist and a full time subject matter expert with Decision Health Professional Services.  In this role she continues to  provide consulting to agencies nationally, as well as develop innovative new products and publications for the home health and hospice industry.

NEW RESOURCES

One of the most exciting aspects of the acquisition is its immediate impact on Home Health Solutions LLC’s on-line resource library.

“A priority goal for 2016 has been a major expansion of our resource library, with a focus on offering affordable, quality online courses for CEUs,” J’non said.

The acquisition of Transitions makes available additional training and education materials to supplement the signature CEU Suite  launched this year by HHS. With new coding courses and an array of programs targeting specific problems such as Face-to Face Encounter documentation, HHS is creating a go-to arsenal of training tools agencies can use to streamline their operations, address problems and shore up bottom lines.

“We have even more resources now to insulate agencies from the risk of non-compliance, and set them on track for higher quality performance and better patient outcomes,” J’non said.

PARTNERING WITH HHS

J’non reiterated that there has never been a better time to partner with HHS.

“We’re really excited about our growth, and we welcome any other agencies looking to become part of our commitment to help agencies achieve and sustain quality and profitability,” she said. “Contact us, and let’s talk about what we can do for your agency.”

 

 

5 Essentials for Your Agency’s F2F Documentation

Can you list the 5 Must-Haves to insulate your home health agency against claims denials based on insufficient Face-to-Face Encounter (F2F) documentation?
Do you know how to incorporate missing elements of the F2F into the medical record?
If you blinked uncomfortably, you’re not alone. These questions are making many home health professionals nervous in the wake of voluminous claims denials after reviews under the Center for Medicare and Medicaid Services “Probe and Educate” Strategy.
Quality Checklist Infographic smaller f2f“It was mind-boggling to  learn early in 2016 that an astonishing 508 of 595 initial claims reviewed under ‘Probe and Educate’ had been denied, ” recalls Home Health Solutions LLC owner and president J’non Griffin.
Over the next few weeks, as reasons for the denials were publicized, it became clear that one of the biggest problem areas for home health agencies consisted of missing, invalid or incomplete documentation for Face-to-Face Encounters (F2Fs) between home health patients and physicians.

F2F REQUIREMENTS

The F2F is mandatory for a patient’s home health certification. It ensures that all orders and certification for home health services are based on a physician’s current knowledge of the patient’s clinical condition. CMS requires that it occur within a specific time frame and address specific information about the patient.
Many agencies relying on forms to capture F2F information discovered that the forms they were previously using omitted details necessary under new CMS requirements.  Agencies also ran into trouble by relying on a physician’s verbal acknowledgement that the F2F had occurred, documenting the encounter and asking the physician to sign.
Some agencies did not understand the distinction between a certifying physician and the primary care physician. Others had not adequately established the patient’s homebound status in records submitted.
Correct procedures for F2F documentation require a brief statement by the certifying physician describing the patient’s clinical condition during the encounter, supporting the patient’s homebound status and the need for skilled services.
While it sounds straightforward, obtaining correct documentation from the physician, complete with required dates and signatures, all in a manner meeting CMS expectations, has proved to be an ongoing challenge for home health agencies.

TRAINING CAN CLEAR THINGS UP

If your agency is struggling with the nuances of F2F requirements, a small investment in training could pay off with major reduction in the risk of claims denials.
Home Health Solutions has just released a recorded training session in which HHS Director of Special Projects and Appeals Heather Calhoun breaks down each component, explaining in detail the five objectives of F2F requirements and specifically how agencies can meet each objective.  During the 90-minute presentation, she outlines three specific ways an agency can incorporate missing elements of the F2F into the medical record, makes clear the homebound status requirements which must be met, and establishes the difference between certifying and primary care physicians.
“You’ll love Heather’s down-to-earth approach to training,” J’non promises. “She has the hands-on experience needed for true peer-to-peer mentoring that goes an extra measure beyond the typical classroom approach.  She delivers all the information you need to understand F2F requirements, and she does it with a practical and engaging style that you’ll appreciate.”

Click here to check out the F2F training program now available  in the HHS Online Store.

 THE 5 ESSENTIALS

The HHS  infographic below provides a quick checklist of the 5 essentials which must be in your agency’s F2F documentation.  Each is explained in detail in the HHS training program.

Quality Checklist Infographic F2F Take 5