Tag Archives: ICD-10

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

 

    

Home health agencies brace for next 6 months

Main art July SolutionsWith six months of adjustment to the 68,000 new health codes known collectively as ICD-10-CM now under its belt, the home health industry is buckling up for Round 2: six more months of new codes to assimilate, code revisions to integrate and new pre-claim reviews to handle.

More than 2,500 changes to the ICD-10-CM classification set are expected to be implemented Oct. 1: at least 1900 new codes, some 350 revised codes and more than 300 deleted codes.  The Tabular List will change, some Excludes Notes will shift and others will disappear completely in this first reworking of the code set since its implementation at the first of this year.

While home health adapts to this newest version of the new classification set, agencies in at least 5 states will also grapple with rollouts of new pre-claim reviews changing the way they process claims for services.  The Centers for Medicare and Medicaid Services (CMS) will require agencies in the affected states to secure prior authorization before processing claims.

Home health agencies in other states, expecting to soon be under the same requirement,  will pay close attention to next month’s initial rollout in Illinois, as well as similar implementations in Florida on Oct. 1, Texas on Dec. 1, and both Michigan and Massachusetts on Jan. 1.

Don’t even think about muttering a “whew” under your breath — at least not yet. There won’t be any rest for the weary at the end of these next six months.

In fact, what’s in store next could possibly have one of the largest impacts yet on home health.

THE IMPACT OF OASIS C-2

It’s hard to overestimate the importance of the Outcome and Assessment Information Set, the CMS data collection tool known by the acronym OASIS, to a home health agency’s operation. This intake of information can affect patient outcomes, reimbursement, STAR ratings, Value Based Purchasing and an agency’s bottom line.

And it’s about to become even more important.

The revised version known as OASIS C-2 becomes effective on Jan. 1, 2017, ratcheting things up a few notches with the implementation of the first quality measures from the Impact Act of 2014. This Act establishes some standardized measures for easier reporting and sharing of data between skilled nursing facilities, long-term care hospitals, inpatient rehabilitation facilities and home health.  The goal is to facilitate coordinated care and improve patient outcomes, providing better post-acute care for Medicare beneficiaries.

Some OASIS C-2 items, for example, are designed to help capture standardized reports of skin integrity, a patient’s functional status and cognitive function, medication reconciliation, incidence of major falls, transfer of health information and care preferences during a patient’s transition from one facility to another.

“As integral as OASIS has become to the success of home health agencies, it is only going to become more crucial in the future,” says J’non Griffin, owner of Home Health Solutions LLC.  “Moving forward with the Impact Act initiatives in a value based environment, inaccuracy in OASIS reporting will cost agencies not only valuable dollars but also referrals. Providers will only want to partner with agencies that have excellent outcomes.”

In the five states selected for pre-claim review, OASIS C-2 will be one of a triad of components integral to set up patient eligibility and establish medical necessity.  OASIS C-2 data will be used along with the patient’s comprehensive assessment and supporting documentation from the care provider to demonstrate why home health is necessary and support the pre- claim.

Home Health Solutions is offering assistance to agencies in the five initial states for reviewing and submitting those claims, and will expand the services to other states as needed. One of the first efforts the  HHS team undertakes when working with agencies on their pre-claim reviews  is stressing the importance of accurate OASIS completion.

Successful home health agencies, according to J’non, will be those who understand how crucial it is to collect OASIS information accurately, maintain effective and ongoing staff training and review to ensure continuity and efficient adaptation to changes, and develop a reliable system to bridge potential glitches such as those caused during periods of staff turnover.

Every employee needs training, every employee’s understanding of the material needs to be reviewed and every employee’s training needs to be updated regularly in order to maintain quality expectations.

“Because of the complexity and the frequency of changes not only in regulations but in the caregiver turnover in agencies, OASIS training is a continual education process,” J’non says. “Success can’t be achieved with a ‘one-and-done’ type training with clinicians.”

A LOOK AT C-2 CHANGES

The new version of OASIS will add several new items, including a GG-Functional section, and modify how some items are worded or numbered. Five items are revised and clarification is provided with regard to many of the questions submitted to the OASIS Help Desk.  “In addition, there are some major wound guideline changes that could mean a significant decrease in case mix points,” J’non says.

Perhaps the most surprising change for many clinicians has been a startling change in how pressure ulcers are to be reported under OASIS C-2, but there are numerous other changes that will require clinicians to undergo a thorough training session in order to best adapt, J’non says.

She is putting the finishing touches on an all new online training session for OASIS C-2 which, while not yet available for purchase at the time of this post, is expected to be uploaded to the Home Health Solutions LLC Online Store within the next week to 10 days.

Browse all the products on our  online store at:
The HHS Online Store

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.