November 28, 2012
There’s a lot of hype about the world ending in 2012. I don’t believe that, but it reminds me of an REM song & M1024—“It’s The End of the World as We Know It.”
Why? M1024 and its predecessors, M0245 and M0246 have been a part of our home health coding world since 2003 when we started using V codes in our coding. Medicare’s final rule for PPS 2013 limits the use of M1024 to only one particular instance for payment diagnoses beginning Jan. 1, and the plan is to decimate it all together once ICD-10-CM is ushered in Oct. 1, 2014. I applaud deleting M1024 from the OASIS, but I desire a different outcome with the remnants of M1024.
M1024 will be used for fractures only beginning in January. Medicare, in a surprise move, stated that resolved conditions do not belong in M1024 and we shouldn’t have been earning points there. CMS reports that the change will be minimal to our case mix scoring, however other sources report that as many as 60% of our assessments include resolved case mix diagnoses in M1024—that will mean a drop in our payment.
We can still get primary points for diabetes, Neuro 1 and Skin 1 case mix diagnoses if we sequence correctly without using M1024 according to Medicare’s grouper change. But, there is one frequently used method for coding that can mean the end of those points if coders are not careful (less points = less money for those who need it spelled out).
I have a short recording on the change to M1024 that will be posted on my website soon and do not miss the opportunity for more in-depth instruction on the change and its impact in upcoming classes in Dallas and Corpus Christi in December. Check my website for details.
So, it’s the end of the world as we know it. It remains to be seen if we’ll “feel fine.”
November 11, 2012
I have received another email from someone who attended my class asking me to verify that 401.9 is a valid code … others at her agency are telling her that it is not a valid hypertension code.
It is. 401.9 is valid. It is a useful code and one that you may have to use, depending on documentation.
401.9 is a valid code and is the correct code for HTN when no other information is available. It would be upcoding to change your hypertension code if you did not have additional information. There are many codes that we use that do not provide points, and this code is no longer case-mix. We must code according to the patient’s condition and the coding guidelines regardless whether the code is case-mix. Remember that if the patient has a heart condition, such as acute MI, chronic insufficiency, CAD or heart failure, then you’ve still earned those points that used to be awarded for 401.9.
September 5, 2012
I’m bringing my one-day OASIS training to Grapevine, Texas, on Oct. 12!!
Achieve OASIS-C accuracy, improve case-mix and outcomes scores, and receive full and prompt reimbursement by attending this full-day intermediate-level OASIS-C training course.
Work through interactive patient scenarios updated with the latest from CMS
including new wound guidance.
- Receive full reimbursement with tips for answering key case-mix items
- Improve outcome scores with clues for navigating the nuances of related items
- Get assessment and intervention strategies for answering OASIS-C process items
- Avoid ADRs and denials
- Bonus: Use this class to prepare for the HCS-O certification exam.
Learn more and register!
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.
December 5, 2011
It’s not too late to sign up for my OASIS: Strategies for Success seminars!
We’re touring in:
Dec. 5-6: Houston
Dec. 13-14: Dallas
This is beyond basics. Here are some highlights of what we will focus on:
- What OASIS is used for, and why accurate and consistent assessment really matters
- How to score OASIS items on a Start of Care assessment
- Techniques to improve assessment accuracy and speed
- How responses to individual OASIS items impact your agency’s reimbursement, OBQI outcome scores, and OBQM avoidable events
- How the new risk adjustment model works, and how your clinicians’ OASIS responses shape your agency’s case mix profile and outcomes
- How to put all the pieces together to improve care delivery and quality outcomes
Learn more and register!
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!
September 26, 2011
All 173 codes are now 5th digits, following the recent trend in neoplasm codes. The bigger issue with these five-digit codes is that CMS has only designated 173.09 as a case-mix code, not the other codes. This takes away our case-mix codes. Almost all neoplasm 173 codes were all case-mix before the 2012 list came out. That should not be done without rulemaking, so there are may queries in to CMS about this issue.
Remember that the codes follow a patter with the 5th digit:
0 = unspecified
9 = other specified (and this is the case-mix code)
Also remember that the codes affected are not melanoma codes.
August 4, 2011
My new codes seminar is rapidly approaching … come listen Aug. 19, 1-2:30pm CDT for a few highlights of the nearly 200 new and changed diagnosis codes for 2012 including:
• Expanded codes for E coli from one to 4 new codes.
• 40 new skin cancer codes that will add both case mix and non-routine supply points.
• New probably case mix codes for dementia without a specific underlying etiology will allow recognition of the presence or absence of behavioral issues and a change to what is described as a behavioral issue.
• Changes to the V code for history of pulmonary embolism.
• New complication codes associated with gastric band surgery, cystostomies and stem cell transplants.
• Specific V codes for acquired absence of joints when a prosthetic joint has been removed and replaced with a spacer.
July 5, 2011
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 …
May 26, 2011
Thank you to a subscriber who asked about a recent entry … sometimes we all lose track of the information floating in our heads:
Question: I have been following your blog entries. On April 15, 2011, you blogged that the resolved case-mix codes need to be placed on the POC. You suggested field 21. In order for me to change a current practice, I need the resource for your quote. I can not seem to find it in the CoP’s. Would you mind giving me the resource?
Lisa says: That was actually an older blog that got recycled by mistake.
There was a requirement in the OASIS manual, but when the OASIS manual was revised it was omitted. We dont know whether it was omitted by mistake or on purpose.