Tag Archives: home health coders

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.

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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.

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