Home Health Insight

I receive many, many questions on M1024, OASIS’s payment question. I recently had this one:
Question: I am trying to get some clarification on when to fill in M1024 if a V code is used in place of a case mix. It was my understanding that you would fill in M1024 if a V code was used in the primary spot for an acute or resolved condition or a DM, Neuro or Skin 1 code. You would not fill in M1024 for a V code in the primary spot if the condition was still active and going to be listed in the secondary spots, other than the DM, Neuro or Skin 1 code.
Also what about V codes in the secondary spots, do we need to fill in M1024?

Lisa says: Remember that M1024 was created as a payment slot for when V codes replace diagnosis codes. This way, the patient’s condition is fully represented. M1020 and M1022 deal with active diagnoses. M1024 is mainly for resolved diagnoses, but CMS has made a few exceptions to this general rule.

The OASIS manual offers a lot of guidance on when to use M1024, and it boils down to these situations:
• When a V code replaces a resolved case mix condition that is the reason the V code is placed in M1020 or M1022.
• When a V code replaces a fracture. Fractures are acute diagnoses, so they are not allowed in M1020 and M1022, per official coding guidelines. We can place them in M1024.
• Use M1024 when a V code in M1020 replaces a diagnosis from the Diabetes, Skin 1 and Neuro 1 case mix categories, regardless of active or resolved status. These three case mix categories are the only ones that receive different case mix points based on whether they are coded primary or secondary. CMS has allowed coding of active conditions in M1024 in these very specific conditions. Still code these three categories in M1022 when active.

If a diagnosis code is active, and therefore eligible for coding in M1022, it cannot be listed in any M1024 slot, with the exception of the three categories listed above.

Yes, you should fill out M1024 in secondary slots, as long as the etiology is for a different underlying, resolved condition than a diagnosis listed in another M1024 slot. For example, if resolved breast cancer is the reason for V codes in M1020 and M1022, don’t put 174.9, the breast cancer code, in both M1024 slots. You have already represented the disease in the M1024 slot across from M1020. Don’t put it across from an M1022 slot, as well. If you code multiple V codes and each has a different etiology, certainly list each across from the appropriate V code. Only case mix codes are eligible for M1024, but there is more than case mix at play: risk adjustment can also be recognized in M1024 slot.

Remember: Only case mix codes are eligible for M1024.

Keep in mind this compliance issue: All M1024 and resolved conditions must be on the plan of care, even though M1024 is not part of the claim. There is no “official” or “right” place to put these conditions, but Locator 21 is an often-used documentation spot.