Archive for July, 2011

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July 27, 2011

Attack of the Vs

As usual, there are a large number of V code changes as the code year changes. A look at some that we might use …. appropriately and sparingly!

V12.5 Diseases of circulatory system: The subclassification at V12.5x now splits out venous thrombosis and pulmonary embolism. History of pulmonary embolism has its own code: V12.55.
V12.5 Diseases of circulatory system
      Excludes: history of anaphylactic shock (V13.81)
    V12.51 Venous thrombosis and embolism
      Excludes: pulmonary embolism (V12.55)
    V12.55 Pulmonary embolism

V19.1 Family history of other conditions, other eye disorders, now includes a family history of glaucoma code (V19.11)
V19 Family history of other conditions
    V19.1 Other eye disorders
      V19.11 Glaucoma
      V19.19 Other specified eye disorder

V40 Mental and behavioral problems now takes on Wandering in diseases (see the post on dementia!)
V40 Mental and behavioral problems
     V40.3 Other behavioral problems
       V40.31Wandering in diseases classified elsewhere
         Code first underlying disorder such as:
           Alzheimer’s disease (331.0)
           autism or pervasive developmental disorder (299.0-299.9)
           dementia, unspecified, with behavioral disturbance (294.21)
           intellectual disabilities (317-319)
       V40.39 Other specified behavioral problem

V54 Other orthopedic aftercare
     V54.8 Other orthopedic aftercare
       V54.82 Aftercare following explantation of joint prosthesis
           Aftercare following explantation of joint prosthesis, staged procedure
           Encounter for joint prosthesis insertion following prior explantation of joint prosthesis

V55 Attention to artificial openings: Note the new exclusions because of the new cystostomy complication codes
V55 Attention to artificial openings
Excludes: complications of external stoma (519.00-519.09, 569.60-569.69, 596.81-596.83, 997.49, 997.5)

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July 24, 2011

The human factor in home health

There is so much talk about how we can automate health care of improve processes. What about the human factors of home health?

AHRQ and the National Academies have wondered about it, too. A report has been released from a 2009 working group. The new report outlines the impact of technology, environment, policy and human factors on the growing field of home health care.

Health Care Comes Home: The Human Factors, describes the areas in which human factors can influence health care in the home; what devices and tools are available; and the changes health information technology has created in the delivery of home health care.  It also discusses the ways different cultures approach health care in the home and the effects that policy and regulations can have on health care in the home.  The report offers recommendations on next steps to ensure quality health care in the home setting.

If you want to read the report, download the PDF. Ordering the paper copy does cost you some money. Select to read the report and recommendations and select for the designer’s guide.

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July 18, 2011

Cystostomy gets its codes … about time!

We’ve known for a long time that there should be more specific cystostomy codes, and the 2012 code set is finally helping us out.

596.8 is now 596.8x … a subclassification dealing with cystostomy infections and complications. Until Oct. 1, we will still be forced to code cystostomy infections with the vague 997.5, Urinary complications. After that, it’s a bonanza of 596.8x codes, and I think that they will be case-mix.

Don’t forget to scan documentation for the specific organism or reason for infection with 596.81, Infection of cystostomy.

Important: You cannot code V55.5, Attention to cystostomy, when there is an infection or complication. Ever.

Specifics of the new codes:
596.81 Infection of cystostomy
Use additional code to specify type of infection, such as:
abscess or cellulitis of abdomen (682.2)
septicemia (038.0-038.9)
Use additional code to identify organism (041.00-041.9)
596.82 Mechanical complication of cystostomy
Malfunction of cystostomy
596.83 Other complication of cystostomy
Fistula
Hernia
Prolapse
596.89 Other specified disorders of bladder
Bladder hemorrhage
Bladder hypertrophy
Calcified bladder
Contracted bladder

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July 16, 2011

Read on … this patient has something for everyone

Question:  This gentleman has six pressure ulcers total, 2 of which are unstageable and 4 of which are a stage 4.  I have coded each pressure ulcer by location and stage already and the primary diagnosis as aftercare following surgery because he had surgical debridement of these while in the hospital prior to admission onto services. I feel that is correct, but you may think differently.
He was diagnosed with severe osteo while in the hospital and also had debridement of the bone as well as the wounds. He is on po levaquin now in the home and was discharged with dx of osteo, so I am assuming that the surgical debridement and IV antibiotics while in the hospital did not rectify it all.  So, I am not sure how to add the dx it into the sequence of the pressure ulcers, maybe secondary, but not quite sure on that.

educating and providing care to this as well.  So, I know that I need to add “colostomy status (v44.3)” and “attn to colostomy, (v55.3)” in the sequence. Our primary focus in the home of course is the wounds, but the colostomy is very important as well, so do I sequence it under the wounds? The wounds just take up so much in the coding scenario that I do not want the colostomy to get missed or I put it too far down in the “line up”.

I am still unclear how to code for supplies on this and we will be providing to him his colostomy supplies.

He is a paraplegic (344.1), so of course I will code that and he also was diagnosed sarcodosis (136.5?) leukocytosis (288.60) and malnutrition (236.9?).

Lisa says: Because you have several stage 4s code the locations and then add the 707.24 for stage 4. I would then code the paraplegia. The V code for attention to colostomy can be used as the 6th diagnosis if you feel strongly that it needs to be coded in the top six. NEVER code the status and attention to codes for the same ostomy at the same time. 
Add the other codes in any order keeping in mind that the other two ulcers are coded as unstageable. 
I would not code aftercare in this situation at all. You are not really providing aftercare. 
Other general reminders: the same code cannot be used more than once so there is no way to code two ulcers at the same site nor is there any way to code bilateral ulcers. 
Non routine supply points in this case are obtained from how M1630 (bowel ostomy), M1308 and M1324 (pressure ulcers) are answered, not on the codes. This scenario is getting a LOT of NRS points so ensure that the appropriate revenue codes and charges are added to your final bill and your HIPPS code ends in a letter (provided supplies). 

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July 14, 2011

Will 294.20 and 294.21 take over as main dementia codes?

Two of the code set that go live Oct. 1 are new dementia codes 294.20, Dementia, unspecified, without behavioral disturbance
(Dementia NOS), and 294.21, Dementia, unspecified, with behavioral disturbance (This code includes dementia with Aggressive behavior, Combative behavior, or Violent behavior.

We have been coding with 294.10 and 294.11, which indicate Dementia in conditions classified elsewhere either with (.10) or without (.11) behavioral disturbance.

There are no Code First, or Code Underlying commands for the new 294.2x codes, so they hold an advantage that they shouldn’t be manifestation codes like the 294.1x codes. This means the 294.2x should be valid when you don’t know the disease causing the dementia, but  you have the dementia diagnosis.

It’s hard to say how much these new codes will “take over” the 294.1x codes, but hopefully, they will reduce the coding of the more vague 294.8 (Other persistent mental disorders due to conditions classified elsewhere).

Note: If your patient wandered off because of the dementia, 294.11 may have been your code, but Wandering off has been stripped from that code. See if Wandering in conditions classified elsewhere (V40.31) might describe your patient’s condition.

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July 6, 2011

Eye and adnexa, ear and mastoid cover two ICD-10 chapters

Another posting on ICD-10 just to get everyone a little more familiar with the way codes work!

ICD-9 lumps Diseases of the Nervous System and Sense Organs into one chapter, Chapter 6. The specificity of ICD-10, and the fact that ICD-1o groups by anatomy (What a thought! Eye diseases with other eye diseases!) mean big changes to this coding area.

ICD-10 Chapter 7 (H00-H59) deals specifically with Disease of the Eye and Adnexa; Chapter 8 (H60-H95) is devoted to the Diseases of the Ear and Mastoid Process, for example.

The organization, which plays into a logical coder’s mind, means that anatomy knowledge will become more and more important. The eye has several structure and parts from the lens (H25-H28) to conjunctiva (H10-H11) to the cornea (H15-H22, which include other parts, such as the iris) for example.

How about glaucoma? We keep getting new glaucoma codes in ICD-9, partially help map to the codes in ICD-10. Here’s the high-level view of glaucoma coding:

Glaucoma (H40-H42)

H40.  Glaucoma

H40.0 Glaucoma suspect

Ocular hypertension

H40.1 Primary open-angle glaucoma

H40.2 Primary angle-closure glaucoma

H40.3 Glaucoma secondary to eye trauma

H40.4 Glaucoma secondary to eye inflammation

H40.5 Glaucoma secondary to other eye disorders

H40.6 Glaucoma secondary to drugs

H42. Glaucoma in diseases classified elsewhere

McClanahan, Debbie

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July 5, 2011

Hypertension gets tha axe in proposed rule

The calendar year 2012 home health proposed rule is proposing a few changes that could greatly affect payment to HHAs:

  • 401.1 and 401.9 may be removed from the case-mix list. CMS has done a series of analyses on use of the codes and resource use. The agency proposes removing these to more accurately align resources and payment use.
  • Lowering payments on high therapy episodes
  • Adjusting case-mix weights

More to come soon …

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July 5, 2011

Payments will decrease if 2012 proposed rule goes into effect

A proposed rule in the Federal Register on Tuesday proposes a 3.35 percent decrease in Medicare payments to HHAs for calendar year 2012. This would be an estimated net decrease of $640 million compared to HHA payments in CY 2011.  It would include the combined effects of market basket and wage index updates (a $310 million increase) and reductions to the HHPPS rates to account for increases in aggregate case-mix that are largely related to billing practices and not related to  changes in the health status of patients (a $950 million decrease). 

Provisions of the Affordable Care Act (ACA) mandate that CMS apply a one (1) percentage point reduction to the CY 2012 home health market basket amount; this would equate to a proposed 1.5 percent update for HHAs next year.  As part of the HH PPS rate update, CMS also proposes to reduce HH PPS rates by 5.06 percent in CY 2012 to account for the increase in the case-mix that is unrelated to changes in patient acuity.

The Medicare HHA proposed rule would also make structural changes to the HH PPS by removing two hypertension codes from the case-mix system, lowering payments for high therapy episodes and recalibrating the HH PPS case-mix weights to ensure that these changes result in the same amount of total aggregate payments.      

The proposed home health market basket increase for CY 2012 is 1.5 percent.  HHAs that submit the required quality data would receive payments based on this full home health market basket update.  If an HHA does not submit quality data, the home health market basket percentage increase would be reduced by 2 percentage points to -0.5 percent for CY 2012.

See the proposed rule.

 

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July 4, 2011

No E923s, I hope

I hope that everyone has had a good Fourth and that we’ve all survived the day without any E923 codes. (Specifically, E923.0)

Happy Fourth!

 

 

 

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