Category Archives: home health coding

5 ways we can help home health coders

coders need community
Are you a home health coder interested in keeping up with frequent changes to the ICD-10 classification set, and how it’s interpreted? If so, you need a regular source of information to keep you updated.

Maybe you’re new to home health coding, in need of free practice scenarios and study material and eager to sharpen your coding skills as you prepare for your home health exam.

Either way, you need a supportive community of coders to help you navigate the complexities of the field you’ve chosen — and Home Health Solutions LLC has the solutions you need.

Here are five ways we’re in the trenches with you, helping you master all the challenges of the home health coding profession:

 1. Free coding and OASIS tips on Mondays

newsletter 2Our free weekly e-newsletter is filled with coding and OASIS tips as well as other news of interest in the rapidly-evolving home health field. We know you’re busy, so we deliver it straight to your Inbox every Monday.
Recently, we’ve featured an update on new guidance regarding the link between HTN and heart or kidney involvement, a look at a common OASIS error regarding the entry of dates, and a refresher on THE MONDAY FIX 7the use of the 7th character in wounds coding.
We’re working now on a series of helpful tips on fractures coding and more common OASIS errors.

   If you haven’t subscribed, click here to add your name to our list and you’ll begin receiving this helpful free e-newsletter next Monday. It’s a great time to subscribe, as we’ll soon begin highlighting some of the changes to the ICD-10  classification set that will become effective Oct. 1.

 Our web site has some treasures

     Are you looking at the Home Health Solutions web site regularly to discover all the helpful info we post there?
coding errors blog post art smaller 1
Check out the PRACTICE CODING QUIZ  we’ve just posted. It features 6 trauma wounds cases and invites you to choose the correct code, assigning A or D as the 7th Character. New home health coders  — or those who like to review from time to time — will also discover useful blog posts on topics such as “Four Common ICD-10 Potholes and How To Avoid Them.”

Did you know that we keep a CODING TIPS ARCHIVE on our web site, where some of the coding tips from our weekly e-newsletters are featured in case you missed them?
Heart Translation GuideIf you like visual aids, be sure to click here to check out our helpful infographics, such as the one pictured at left. These graphics are designed to pack helpful information into a visual form, and can be printed out for you to keep with other useful tips.
   Your agency may benefit from “Think Like an Auditor,” our free report on the Top 25 Documentation Errors the HHS Team encounters when working with home health agencies, or by taking THE HHS SECURITY QUIZ, a 5-minute tool designed to help you target areas where you may be out of compliance. The Security Quiz highlights many items which will be noted during Survey.
And, speaking of Survey, did you miss our blog post on an often-overlooked but important area: “How Does Your Agency Handle Complaints?” It offers a helpful list to help your agency shore up the way complaints are documented and addressed.  Be sure to share the links to these items with the appropriate person in your agency.

3. Our Code & Coffee Quiz on Facebook

barbershop quartet art 2Whether you’re a veteran or a novice at home health coding, we have a great educational tool for you every Monday on the Home Health Solutions Facebook page.
Our Code & Coffee Quiz posts a home health scenario with multiple-choice coding sequences, inviting coders to tell us in the comments which sequence they like best and why. One of them is rewarded (in a random drawing) with a $10 e-card to Starbucks — but everyone’s a winner on this weekly quiz, because of the learning opportunities it provides.
   Recent scenarios have featured great examples of new coding guidance on presumed relationships and examples of diagnoses that require a step beyond — and then two more beyond that — with regard to specificity.

The Quiz is pinned to the top of our Facebook page each Monday. Click here to check it out.  (While you’re there, scroll down on the Facebook page to review some quizzes from previous weeks.)

Here are just a few of the reasons you should be joining us every Monday for the Code & Coffee Quiz:

  • You’re a new home health coder who needs the practice every week,
  • You’re an established home health coder who wants to see practical examples of new coding guidance in use
  • You’d like to win a $10 e-card to Starbucks
  • You recognize the value of a weekly forum where coders can discuss scenarios with the rationale provided, learning from each other


 4. Our
Online Store has products you need

    We know you need CEUs and training to stay abreast of constant change in the home health field, so we’re constantly working on new online training programs for you.
When
Home Health Solutions owner J’non Griffin isn’t on the road to teach a workshop or take the stage as a featured speaker for an industry event, she’s recording online training classes. She just finished an OASIS C-2 update, designed to address revisions which will become effective Jan. 1. It’s worth 8 CEUs. Check it out in the HHS Online Store.

   While you’re there, browse around a bit — and be sure to take a look at our Absolute Auditor classes. These classes are offered both online and in person.

 5. Get connected to stay in the loop

     At HHS, we’re committed to helping home health coders and home health agencies achieve excellence. After you check out the blog posts, classes, newsletters and tools mentioned here, check back soon to see what other helpful information we’ve assembled for you.
A great way to stay in the loop is to “like” us on Facebook so that our posts will appear in your Newsfeed. There’s a “like” box on the bottom right side of this post, to make it easier.

   You can also follow us on Twitter at:

@hmhealthsolutions

 

    

More changes ahead for home health this fall

summer shoreup art for solutions 2

What’s on your summer calendar?
Priorities should be internal audits,
reviews and self-assessments



Editor’s note: This post first appeared in a longer article in the June 9 issue of SOLUTIONS,  the monthly e-newsletter from Home Health Solutions LLC. Click here if you’d like to subscribe to SOLUTIONS.

Summertime, and the livin’ is easy. Unless, of course, you’re in the home health field.

From backyard barbecues to long and lazy afternoons at the beach, this is the time of year when leisure time is foremost in our hearts and minds. But this summer, smart home health agencies are looking beyond the distractions of summer to the fall, when the change of season will usher in a new round of major adjustments.

Home health agencies in Illinois won’t even have to wait until fall; the Centers for Medicare and Medicaid Services (CMS) announced last week  that it will move forward with preauthorization requirements despite opposition from the home health industry. CMS will roll out the first preauthorization program in Illinois Aug. 1.

Four more states will follow throughout the fall and winter, with Florida scheduled for Oct. 1, Texas for Dec. 1, and both Michigan and Massachusetts for Jan. 1.

Rollouts in those states will require home health agencies to perform prior authorization before processing claims for services. The procedure would be similar to the Prior Authorization of Power Mobility Device (PMD) Demonstration, which CMS implemented in 2012. It requires prior authorization for scooters and power wheelchairs within seven states where fraud and errors have been prevalent in the past.

Nationwide, this autumn was already shaping up to bring a round of new challenges to home health agencies. In October, when CMS removes a three-year partial code freeze, some 2,500 changes are expected to become part of the ICD-10-CM classification set. At least 1,900 new codes will be added, 351 codes will be revised and 313 codes will be deleted. The tabular list will change as well.

A few Excludes Notes will shift and some others will disappear completely in this first reworking of the code set since its implementation at the start of 2016.

Exactly how these changes in codes will impact the home health field still isn’t clear, as the complete list of revisions has not yet been provided.

A LOOK AT WHAT’S AHEAD

Be prepared; coding guidelines are likely to change frequently during the adaptation process to the revisions.

Guidelines already change so often with new interpretations that it can be difficult for coders to keep pace. Major re-interpretations just in the past couple of months had coders scrambling this spring to rethink the way diagnoses and comorbidities can now be linked, and how certain heart failure diagnoses can now be coded without further specification by the attending physician.

Many areas of ICD-10 implemented this year have given rise to questions, and as those issues are reviewed and addressed, coding guidance will continue to evolve rapidly with new interpretations and even reversals. It is crucial for agencies and the coders they employ to stay abreast of every change to reduce compliance risks.    And the changes in the ICD-10 set are just Round 1. On the heels of those changes, the Outcome and Assessment Set generally known by its acronym, OASIS, will undergo its own revisions. OASIS C-2 is scheduled for implementation Jan. 1, 2017, and will add new items, renumber some items, and make other changes in how data is collected.

YOUR SUMMER TO-DO LIST
How can home health agencies and home health coders prepare for all these major changes beginning Aug.1 and continuing through early 2017?

“There’s never been a more critical time to shore up your agency’s operation,” advises J’non Griffin, owner of Home Health Solutions LLC.

Addressing and correcting existing compliance risks this summer will better position agencies to handle problems likely to occur during the adaptation process in the fall, reduce the likelihood of home health professionals feeling overwhelmed by constant change, and provide an extra layer of insulation against potential losses due to claims denials, according to J’non.

She recommends agencies prioritize internal audits, quality reviews and other self-assessment measures between now and Labor Day.

“This summer is the time for agencies to take a proactive approach, identifying and addressing the need for quality clinical documentation and code specificity – and then follow up with extra training measures and education efforts in every area where there is any confusion or performance issue,” she says.

In many cases, it may prove more cost-effective and time-expedient for agencies to streamline operations by partnering with a consultant to develop and implement corrective measures, or to outsource some services.

Home Health Solutions is making it easier than ever to get help with a Summer Shore-Up Package, offering limited-time discounts on new services.

Now through Labor Day, the Summer Shore-Up Package from HHS will offer a 10 percent discount off any standard rate of new services. In addition, agencies contracting for coding services under the Summer Shore-Up Package will receive 5 free OASIS analyses with pre and post-HHRG (Human Health Resource Group) values.

“This discount reflects our sincere commitment to help agencies address areas where they may not be prepared to meet an additional round of challenges,” Jnon says. “We want to take some of the anxiety out of the equation for agencies, providing the guidance and services they need to achieve and maintain success in a fluid and challenging market.”

summer hore up coupon

 

 

 

New coding guidance on “with” changes how coders link diagnoses

art for monday fix may 16Editor’s note: This post appeared in the May 16 issue of “The Monday Fix,” a weekly email from HHS featuring coding tips.  Click here if you’d like to subscribe. 

It may be time to rethink the way you’re coding some stated and assumed relationships in light of new Coding Clinic guidance.

Two back-to-back articles released last week by AHIMA proved to be an eye-opener for many home health coders, updating and replacing previous information about cause-and-effect coding practices.
A Code Cracker Blog post on the Journal of AHIMA website and an article in the May issue of Codewrite, AHIMA’s e-newsletter, both referenced new Coding Clinic advice that reverses much of the thinking among home health coders on the use of subterm conditions listed next to primary diagnoses under the category “with.”

The articles acknowledged Coding Clinic advice that the word “with” should be interpreted to mean a cause-and-effect relationship if:
1.The patient has both diagnoses confirmed by the physician, and
2.There is no other cause provided for the subterm condition.

Examples were offered by AHIMA for a diagnosis of diabetes mellitus, which has some 53 conditions listed under the subterm “with” in ICD-10 coding manuals.
Those conditions may now be coded as complications of diabetes mellitus if the documentation supports both and if no other cause is given.
This means, for example, that coders may accurately assign the code E11.22 (for Type 2 Diabetes with Chronic Kidney Disease) if the physician has separately documented that the patient has both DM and CKD. There is an assumed relationship because CKD appears in the list of conditions associated with DM.
And the new interpretation does not apply only to diabetis mellitus and its 53 subterm conditions; it applies to any diagnosis where the word “with” appears above a list of related conditions.
The one noteable exception is hypertension with heart disease.
For many coders, especially those who trained under a different ICD-9 interpretation, the cause-and-effect assumption will prompt a major shift in thinking.
“Anytime we see the word ‘with’ underneath a diagnosis — except hypertension with heart disease — we are now to assume a cause-and-effect relationship unless the physician indicates another cause,’’ explains Kimberly Searcy, Director of Global Education for Home Health Solutions.
Kimberly joined a group of home health coding professionals for advanced coding training in Houston last week, as the home health coding field was abuzz with questions about the new interpretation, wondering exactly how it will affect their coding.
“This confirmation changed the way we have been coding since the beginning,” Kimberly says. “Coding Clinic states they clarified the original guidance in 2009 when the original update to the coding convention was made. Their clarification, however, was never read the way it was intended.”
Instead, home health coders divided into two camps on the issue. In one camp, many coders assumed it was necessary for documentation from the physician to link the main term listed and any condition under the subterm “with,” while the other camp believed the link was not necessary.

Coding Guidelines:
Here’s what the ICD-10-CM Official Guidelines for Coding and Reporting actually states at 1.A.15:
“The word ‘with’ should be interpreted to mean ‘associated with’ or ‘due to’ when it appears in a code title, the Alphabetical Index, or an instructional note in the Tabular List.
“The word ‘with’ in the Alphabetical Index is sequenced immediately following the main term, not in alphabetical order.”

How will this new interpretation apply to you?

If you have been interpreting the guideline incorrectly, in most cases you will simply need to begin applying the clarified interpretation to your current charts, going forward, without correcting any previous charts. Please check with your employer, however, to confirm that you will not need to update any previous charts.

If you are uncertain about whether documentation supports an association between a diagnosis and conditions due to its complications, it is best to send a query to the physician requesting clarification.

“Updated confirmation will be in print form for release in second quarter, but we are to begin now according to the article released by AHIMA,” Kimberly says. “Coding Clinic has given verbal confirmation along with AHIMA.”

She also offers this bit of sound advice to home health coders about the latest change:
“Don’t get too complacent. Be willing to roll with the changes in ICD-10, which are always on the horizon!”

Here’s a case example:

Marti Holthus, a Quality Reviewer and Mentor for Home Health Solutions, provides this example of how the new interpretation might apply in a coding scenario where stated and assumed relationships must be considered:    Your patient has insulin dependent diabetes, hypertensive heart disease, end stage renal disease, and acute on chronic systolic and diastolic congestive heart failure. He goes to the dialysis center 3 times per week. Skilled nursing is ordered for CHF monitoring and teaching.How do you code this scenario when there are assumed and stated relationships between the diagnoses?Assumed Relationships:
You may assume a relationship between hypertension and chronic kidney disease. Per updated guidance from the Coding Clinic, you may also presume a cause-and- effect relationship between diabetes and CKD/ESRD unless the physician indicates another cause. If the patient has hypertensive heart disease, you must select a code for with or without heart failure.Stated Relationships:
As of right now, we may not assume a relationship between hypertension and heart disease. The physician must state the heart disease is due to hypertension or it may be implied (hypertensive).

Focus of Care:
The focus of care in this scenario is the exacerbated heart failure; however, this diagnosis cannot be coded first due to sequencing instructions.

Begin your search by looking in the index under hypertension. Notice that hypertensive heart disease with CKD is listed in the index under hypertension, cardiorenal disease.
From there you must choose between with heart failure or without heart failure. I13.2 is coded because the patient has heart failure and ESRD.
Next locate the code for diabetes with chronic kidney disease E11.22 which must also precede the end stage renal disease code per coding instructions.

The correct coding would be:
Hypertensive heart and chronic kidney disease with heart failure and with ESRD I13.2
Acute on chronic combined CHF I50.43
Diabetes with chronic kidney disease E11.22
End stage renal disease N18.6
Dialysis status Z99.2
Long term insulin use Z79.4

Note that if the focus of care had been diabetes rather than exacerbated heart failure, E11.22 would be listed first, followed by hypertensive heart disease, heart failure, and end stage renal disease.

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.