September 24, 2012
Prior to the news about the postponement of ICD-10 the most common question was, “Why should we continue with ICD-9 training when “10″ is on the horizon?” The answer is simple. At the very least we still need to understand & correctly assign ICD-9 codes until 10/1/13.
I am holding ICD-9 education that also prepares you for the ICD-10 transition in Tampa, Florida; Houston, Grapevine, and Corpus Christie, Texas.
We still need training because we are mandated by regulations to only enter accurate information in our patients’ records. Erroneous coding can have horrible unintended consequences for the patient whose medical record becomes contaminated by diagnoses that they don’t have.
If you think there’s nothing new in coding, then you’re wrong! There is more scrutiny in the form of medical reviews.
Lisa will provide ICD-9 answers and food for thought for the future, as well as an extra bonus of what’s new with ICD-10-CM and how to best ready your agency for this huge change.
Learn more about my training!
September 7, 2012
Symptom coding is always confusing!
Should I code abnormality of gait for example if my patient has hemiplegia? What about if she’s falling and the physician doesn’t have an explanation for the falls yet?
If you have the DecisionHealth 2012 Complete Home Health ICD-9-CM Diagnosis Coding Manual turn to p. 1039 and read the second paragraph. Some of those examples do not apply to home care but it is a good summary of when we do use symptom codes. The part about integral or not is in the general coding guidelines p.29 #6-8. That should help you think about whether you need abnormality of gait, difficulty walking or any other symptom!!
By the way, those symptom codes are not required just because you’re adding therapy to the mix. There is no separate set of rules when it comes to coding for therapy in home care!
If you don’t have that particular coding manual, it’s still in your book, because it’s official guidance! For other manuals, look at the first page of Chapter 16 (780-799) and the Official Guidelines for Coding and Reporting, Section I.B.6-8.
August 24, 2012
The Department of Health and Human Services (HHS) announced Friday the final rule that changes the implementation deadline for the transition to ICD-10-CM and ICD-10-PCS from October 1, 2013 to October 1, 2014.
The rule is scheduled to be published in the Federal Register Sept. 5.
HHS concluded that delaying ICD-10 by one year does the least to disrupt existing implementation efforts, and minimizes the costs of delay, while affording the small provider community an additional year to become compliant. In order to assist entities in being prepared to meet the new compliance date, HHS expects to increase education and outreach events and to work with industry on improvements to the overall standards implementation process.
July 9, 2012
I recently received a query on hypertension codes. A client was saying that 401.9 and 401.0 are no longer legitimate, as of January 2012, but coding books ordered after that have these codes.
My response is below:
The coding manual is correct. The codes are valid codes. The coding guidelines have not changed on using 401.9 and 401.1. If the patient has hypertension and there is 1) no stated or implied relationship documented by the physician between the hypertension and heart failure and 2) no chronic kidney disease or renal sclerosis, then the 401 category is correct for hypertension.
Furthermore, if the 401 category is correct (as is usual), then 4th digit 9 (unspecified) is usually correct because the physician doesn’t specify benign or malignant.
What did change is the case-mix status of 401.9 and 401.1. Those two codes are no longer case mix meaning they do not earn points. But alas, do not be discouraged. Many patients who have hypertension also have CAD, chronic ischemia, heart failure or the like, and those diagnoses earn the same points that 401.9 and 401.1 used to earn.
Continue to code hypertension when it is pertinent to your POC. The codes ARE allowed. What is important is to NOT change the code you use for HTN just to get points. CMS is looking for that type of behavior.
The coding manuals were published prior to the final rule from CMS on case-mix status so all you’ll need to do to update your manual is to write “NO $” next to those two codes.
June 26, 2012
We’re teaching in Texas in July! Come join SHA for coding education in McAllen July 9-10 and Dallas July 30-31.
Beginners: The coding book is friendly if you know how to use it!
- PLUS: 3.75 nursing contact hours and 3 CEs toward HCS-D maintenance
Intermediate: Go over basic skills, move to PPS, case-mix, RAC targets, and complicated scenarios.
- PLUS: 9.75 nursing contact hours and 9.75 clock hours for administrators and 10 CEs toward HCS-D maintenance
April 16, 2012
Just a reminder of a few codes that became invalid Oct. 1. Don’t code!
A few we’ve seen:
- 286.5, Hemorrhagic disorder due to intrinsic circulating anticoagulants
- 518.5, Pulmonary insufficiency following trauma and surgery
- 999.4, Anaphylactic shock due to serum
- 999.5, Other serum reaction
- V12.2, Personal history of endocrine, metabolic, and immunity disorders
- V13.8, Personal history of other specified diseases
March 26, 2012
The HHS Office of the Inspector General conducted a study looking at home health claims from 2002-2008 and found that$432 million in Medicare monies were inappropriately paid either because medical necessity was not established or coding was inaccurate. Millions more dollars were lost to CMS or HHAs because of upcoding or downcoding.
The number of HHAs grew from 7,052 to 9,801, and increase of 39 percent. Medicare spending on home health increased 84 percent from $8.5 billion in 2000 to $15.7 billion in 2007. The sharp rise in payments created the push to investigate payments.
HHS reviewed the claims of almost 500 beneficiaries to see whether Medicare coverage requirements were met.
The office found that 22 percent of claims were in error because services were not medically necessary or claims were coded inaccurately, resulting in $432 million in improper Medicare payments. Also, HHAs upcoded about 10 percent ($278 million) of claims and downcoded about 10 percent ($184 million) of claims.
OIG believes it needs to investigate more to determine what services are met and what potential for fraud is involved.
Read the complete report.
November 23, 2011
Several questions in CMS’s 3rd quarter Q&As deal with pressure ulcers and M1308.
The highlights (in my words, not CMS’s!):
- Should a muscle flap be reported in M1308 as a current pressure ulcer? No. It is a surgical wound (as are skin advancement flap, or rotational flap)
- If the pressure ulcer has a skin graft, how is it treated? Not as a surgical wound but as unstageable until it heals, then Stage III or IV.
- How do you report a Stage III that is closing to the point of a pinpoint? As a Stage III …
Find CMS’s full answers here.
November 14, 2011
CMS has clarified that payment changes relative to the removal of the hypertension codes will be effective with M0090 dates of 1/1/2012.
“Beginning with M0090 dates of January 1, 2012, 401.1 Benign essential hypertension codes and 401.9 Unspecified essential hypertension are removed from the HH PPS case-mix system. Specifically, 401.1 and 401.9 diagnosis codes will no longer result in additional points when computing the HIPPS codes”
Providers should not change the codes they use for hypertension unless they have been coding the 401 codes in error. Changing the codes just to get points is upcoding and we certainly do not want to prove CMS correct about case mix creep. You can be sure that they will be watching for trends in hypertension coding as a result of the case mix change.
Remember hypertension with chronic kidney disease (585) or renal sclerosis (587) changes the hypertension code to the 403 category. There is a presumed relationship between CKD and HTN with HTN causing the CKD.
However, a relationship between heart disease and HTN cannot be presumed. The physician must either state (e.g., heart failure due to hypertension) or imply the relationship (e.g., hypertensive heart disease).
Even if you do not have the information to be able to change the hypertension code to some other category besides 401, do not despair! Remember that hypertension and heart disease are together in Table 4. Even if you do not earn points with the hypertension codes, think how many of your patients with 401 codes also have codes from the 414 category (coronary atherosclerosis and chronic ischemia), 410 (acute myocardial infarction) and 428 (heart failure). Those codes are case mix, too, so you will not be losing any points!
October 25, 2011
I am already getting questions on dementia coding … here we go!
Question: Now that the new dementia codes (294.10, 294.11) have come out, do we only use them for a dementia related to another condition that was coded and use 290.0 for straight senile dementia OR do we have to use 294.1x for all dementia?
Lisa says: The new dementia codes are 294.20 and 294.21. Those are for dementia NOS. Senile dementia is coded when documented. 294.1x codes for use when associated with physical conditions such as those listed.