Tag 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.
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:




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.


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


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 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.


” 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.


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


 Here is a link:


 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.