June 7, 2017

Summer Equals Melanoma Awareness

Skin cancer is the most common type of cancer in the United States. UV radiation from the sun, tanning beds or sun lamps can lead to melanoma, the most dangerous form of skin cancer. 3.5 million people are diagnosed each year with some form of skin cancer and men over 50 have an increased risk of developing melanoma compared to the general population. Women…keep an eye on your man. Studies show that women are nine times more likely than men to notice melanoma on others.

Shedding some light on tanning beds:
Brazil and Australia have banned indoor tanning completely. Those who have tanned indoors have a 69% higher risk of developing basal cell carcinoma before age 40. People who first used a tanning bed before the age of 35 increase their risk for melanoma by 75%. 12 states have banned the use of tanning beds by anyone under 18.

Not all moles are created equal. A normal mole should be symmetrical. If you notice spots on your body that seem to change in diameter or color, make an appointment with a dermatologist immediately.

Although sun provides us with an excellent source of vitamin D, too much is not a good thing. 90% of skin aging is caused by the sun. Protecting yourself from harmful UV rays on a daily basis with a sunscreen with SPF 15 or higher, reduces your risk by 50%.
So, slather on the sunscreen and don’t forget your hat this summer as you enjoy life’s natural rays.

May 26, 2017

Honoring Memorial Day

On Monday the 29th, the flag of our country will be quickly raised to the top of the staff then solemnly lowered to half-staff position and will remain there only until noon. Then it will rise again to full-staff for the remainder of the day.

The half-staff position remembers those who gave their lives in service of our country. At noon, their memory is raised by the living, who resolve not to let their sacrifice be in vain.

Memorial Day is the unofficial beginning of summer, with Labor Day indicating the end.

Memorial Day is often confused with Veterans Day. Memorial Day honors those military men and women who have died while defending our country and Veterans Day celebrates all service members.

While many of us view this day as a day-off from work, connected to picnics and parades, it is truly a day of remembrance to those who gave their greatest gift for our greatest gift…freedom.

 

God bless America and those who gave their lives for her.

April 18, 2017

Sweet News for Diabetes with Ketoacidosis and More

Sweet News for Diabetes with Ketoacidosis and More

CMS released its proposed list of new codes on Friday, April 14th as part of the physician payment rule. Significant for home health and hospice: New codes for Type 2 diabetes with ketoacidosis and more choices for non-pressure ulcers!

We’ll have to continue coding E13.10 (per Coding Clinic) for our type 2 diabetics with ketoacidosis until October 1, then we will switch to:

E11.10- Type 2 diabetes mellitus with ketoacidosis without coma

Requests were sent for new codes for non-pressure ulcers (L97 and L98) last year. We were concerned that the codes with 6th characters 3 and 4 required muscle necrosis or bone necrosis, which are difficult for clinicians to determine. Clinicians need to do a better job at describing the structures seen, when documenting non-pressure ulcers, so that the 6th character 9 for unspecified can be avoided. New 6th characters 5 and 6 indicate muscle involvement without necrosis and bone involvement without necrosis. We also have been provided codes for ‘other specified severity’ (6th character 8) for when the description by the clinician or the physician doesn’t match up with the other descriptions of severity.

 

New code lists are just part 1 of the coding changes. Coding nerds also look forward to changes in the tabular list, alphabetical index and the coding guidelines. A whole summer of fun for coding nerds!

L97.105-Non-pressure chronic ulcer of unspecified thigh with muscle involvement without evidence of necrosis

L97.106-Non-pressure chronic ulcer of unspecified thigh with bone involvement without evidence of necrosis

L97.108-Non-pressure chronic ulcer of unspecified thigh with other specified severity

L97.115-Non-pressure chronic ulcer of right thigh with muscle involvement without evidence of necrosis

L97.116-Non-pressure chronic ulcer of right thigh with bone involvement without evidence of necrosis

L97.118-Non-pressure chronic ulcer of right thigh with other specified severity

L97.125-Non-pressure chronic ulcer of left thigh with muscle involvement without evidence of necrosis

L97.126-Non-pressure chronic ulcer of left thigh with bone involvement without evidence of necrosis

L97.128-Non-pressure chronic ulcer of left thigh with other specified severity

L97.205-Non-pressure chronic ulcer of unspecified calf with muscle involvement without evidence of necrosis

L97.206-Non-pressure chronic ulcer of unspecified calf with bone involvement without evidence of necrosis

L97.208-Non-pressure chronic ulcer of unspecified calf with other specified severity

L97.215-Non-pressure chronic ulcer of right calf with muscle involvement without evidence of necrosis

L97.216-Non-pressure chronic ulcer of right calf with bone involvement without evidence of necrosis

L97.218-Non-pressure chronic ulcer of right calf with other specified severity

L97.225-Non-pressure chronic ulcer of left calf with muscle involvement without evidence of necrosis

L97.226-Non-pressure chronic ulcer of left calf with bone involvement without evidence of necrosis

L97.228-Non-pressure chronic ulcer of left calf with other specified severity

L97.305-Non-pressure chronic ulcer of unspecified ankle with muscle involvement without evidence of necrosis

L97.306-Non-pressure chronic ulcer of unspecified ankle with bone involvement without evidence of necrosis

L97.308-Non-pressure chronic ulcer of unspecified ankle with other specified severity

L97.315-Non-pressure chronic ulcer of right ankle with muscle involvement without evidence of necrosis

L97.316-Non-pressure chronic ulcer of right ankle with bone involvement without evidence of necrosis

L97.318-Non-pressure chronic ulcer of right ankle with other specified severity

L97.325-Non-pressure chronic ulcer of left ankle with muscle involvement without evidence of necrosis

L97.326-Non-pressure chronic ulcer of left ankle with bone involvement without evidence of necrosis

L97.328-Non-pressure chronic ulcer of left ankle with other specified severity

L97.405-Non-pressure chronic ulcer of unspecified heel and midfoot with muscle involvement without evidence of necrosis

L97.406-Non-pressure chronic ulcer of unspecified heel and midfoot with bone involvement without evidence of necrosis

L97.408-Non-pressure chronic ulcer of unspecified heel and midfoot with other specified severity

L97.415-Non-pressure chronic ulcer of right heel and midfoot with muscle involvement without evidence of necrosis

L97.416-Non-pressure chronic ulcer of right heel and midfoot with bone involvement without evidence of necrosis

L97.418-Non-pressure chronic ulcer of right heel and midfoot with other specified severity

L97.425-Non-pressure chronic ulcer of left heel and midfoot with muscle involvement without evidence of necrosis

L97.426-Non-pressure chronic ulcer of left heel and midfoot with bone involvement without evidence of necrosis

L97.428-Non-pressure chronic ulcer of left heel and midfoot with other specified severity

L97.505-Non-pressure chronic ulcer of other part of unspecified foot with muscle involvement without evidence of necrosis

L97.506-Non-pressure chronic ulcer of other part of unspecified foot with bone involvement without evidence of necrosis

L97.508-Non-pressure chronic ulcer of other part of unspecified foot with other specified severity

L97.515-Non-pressure chronic ulcer of other part of right foot with muscle involvement without evidence of necrosis

L97.516-Non-pressure chronic ulcer of other part of right foot with bone involvement without evidence of necrosis

L97.518-Non-pressure chronic ulcer of other part of right foot with other specified severity

L97.525-Non-pressure chronic ulcer of other part of left foot with muscle involvement without evidence of necrosis

L97.526-Non-pressure chronic ulcer of other part of left foot with bone involvement without evidence of necrosis

L97.528-Non-pressure chronic ulcer of other part of left foot with other specified severity

L97.805-Non-pressure chronic ulcer of other part of unspecified lower leg with muscle involvement without evidence of necrosis

L97.806-Non-pressure chronic ulcer of other part of unspecified lower leg with bone involvement without evidence of necrosis

L97.808-Non-pressure chronic ulcer of other part of unspecified lower leg with other specified severity

L97.815-Non-pressure chronic ulcer of other part of right lower leg with muscle involvement without evidence of necrosis

L97.816-Non-pressure chronic ulcer of other part of right lower leg with bone involvement without evidence of necrosis

L97.818-Non-pressure chronic ulcer of other part of right lower leg with other specified severity

L97.825-Non-pressure chronic ulcer of other part of left lower leg with muscle involvement without evidence of necrosis

L97.826-Non-pressure chronic ulcer of other part of left lower leg with bone involvement without evidence of necrosis

L97.828-Non-pressure chronic ulcer of other part of left lower leg with other specified severity

L97.905-Non-pressure chronic ulcer of unspecified part of unspecified lower leg with muscle involvement without evidence of necrosis

L97.906-Non-pressure chronic ulcer of unspecified part of unspecified lower leg with bone involvement without evidence of necrosis

L97.908-Non-pressure chronic ulcer of unspecified part of unspecified lower leg with other specified severity

L97.915-Non-pressure chronic ulcer of unspecified part of right lower leg with muscle involvement without evidence of necrosis

L97.916-Non-pressure chronic ulcer of unspecified part of right lower leg with bone involvement without evidence of necrosis

L97.918-Non-pressure chronic ulcer of unspecified part of right lower leg with other specified severity

L97.925-Non-pressure chronic ulcer of unspecified part of left lower leg with muscle involvement without evidence of necrosis

L97.926-Non-pressure chronic ulcer of unspecified part of left lower leg with bone involvement without evidence of necrosis

L97.928-Non-pressure chronic ulcer of unspecified part of left lower leg with other specified severity

L98.415-Non-pressure chronic ulcer of buttock with muscle involvement without evidence of necrosis

L98.416-Non-pressure chronic ulcer of buttock with bone involvement without evidence of necrosis

L98.418-Non-pressure chronic ulcer of buttock with other specified severity

L98.425-Non-pressure chronic ulcer of back with muscle involvement without evidence of necrosis

L98.426-Non-pressure chronic ulcer of back with bone involvement without evidence of necrosis

L98.428-Non-pressure chronic ulcer of back with other specified severity

L98.495-Non-pressure chronic ulcer of other sites with muscle involvement without evidence of necrosis

L98.496-Non-pressure chronic ulcer of other sites with bone involvement without evidence of necrosis

L98.498-Non-pressure chronic ulcer of other sites with other specified severity

 

Here is a link to the complete list of new codes.

2018 Proposed Codes

April 12, 2017

Another Way for Them to Take Your Money (Part 2)

Mary Carr at NAHC provides the following information regarding submitting the OASIS prior to claim that I want to share with you.
The edit is not intended to enforce the 30 day OASIS submission time frame.  The edit is checking  that an OASIS has been  submitted prior to the claim and that the HIPPS codes match. The edit is on claims with dates of service after April 1, 2017

When a claim is submitted the edit will look to see if the OASIS is in the system.

  • If the OASIS is present the claim will pay, regardless of whether or not  the OASIS was submitted within 30 days of the M0090 in accord with §484. 55.
  •  If the OASIS is not present, the edit will look to see if the date between M0090 and the date the claim was submitted is greater than 40 days. If these two conditions exist  the claim will deny.    

 

CMS is providing 40 days as a look back period since  agencies are provided  30 days to submit the OASIS and to accommodate any lag time that might occur when a claim and an OASIS  are submitted close to the 30 day time frame.    

 

The OASIS submission date changes in the QIES system with each OASIS modification and submission. However, since the edit is not enforcing the OASIS submission time frame requirement, modifications to the OASIS should not  cause a claim to deny, unless the correction requires an inactivation or deletion of the OASIS and the replacement OASIS is not entered prior to a claim submission.  There could be a small window where corrections to the OASIS could change the OASIS submission date to a date later than the claim submission date prior to the claim processing. We are checking with CMS for clarification on the implications for OASIS corrections and claim submissions.

 

At any rate, agencies should review and retain their validation reports to demonstrate that the OASIS associated with the claim was submitted prior to the claim.

 

Lisa Selman-Holman
Selman-Holman & Associates,LLC
CoDR–Coding Done Right
March 28, 2017

Another Way for Them to Take Your Money

The requirement of submission of OASIS data within 30 days after the M0090 date has always been a part of the Conditions of Participation since the inception of OASIS. The OASIS had to be ready to submit prior to “dropping” of the RAP (Request for Anticipated Payment). Over the years, agencies have received denials in the Additional Development Request (ADR) process when the HIPPS code on the claim did not match the HIPPS code on the OASIS. However, OASIS was submitted to the Quality Information and Evaluation System (QIES) via the state, and claims were submitted to the Medicare Administrative Contractor (MAC) and the two weren’t compared automatically.

Several years ago, the OIG in their annual report, suggested that Medicare should deny claims for which the OASIS was not submitted on time (within 30 days of M0090). Medicare’s response was that they wanted providers to correct any errors in OASIS and when OASIS was corrected, the system saved the new date and not the date the OASIS was first submitted. Well, CMS has come up with a way to ensure that an OASIS is in the system for each claim. MACs have automated the denial of Home Health Prospective Payment System (HH PPS) claims when the condition of payment for submitting patient assessment data has not been met.

That new process will be effective for claims with dates of service on or after April 1, 2017. Upon receipt of a final claim with service dates after April 1, 2017, Medicare systems will check whether the corresponding OASIS assessment is present in the QIES. If the OASIS assessment is not found AND the receipt date of the claim is more than 30 days after the assessment completion date reported on the claim, Medicare systems will deny the HH claim.

While the regulation requires the assessment to be submitted within 30 days of completion, the initial implementation of this process will allow 40 days. Medicare systems will check for assessments used to determine the HIPPS code on the claim (Start of Care, Recertification and certain Resumption of Care assessments). Again, for the claim to be denied, the assessment must be both missing AND past due. When denying the claim, Medicare will apply the following remittance messages:

  • Group Code of CO
  • Claim Adjustment Reason Code 272

Prior to submitting an End of Episode claim, ensure the OASIS assessment has completed processing and was successfully accepted into the QIES National Database. The HHA can verify this by reviewing the OASIS Agency Final Validation Report or OASIS Submitter Final Validation Report for the submission which included the assessment. This may require communication between the provider’s billers and clinical staff that submits the OASIS to CMS.

The following information will be used to find the OASIS to check against the claim so double check this information prior to submission.

HHA CMS Certification Number (OASIS item M0010)

Beneficiary Medicare Number (OASIS item M0063)

Assessment Completion Date (OASIS item M0090)

Reason for Assessment (OASIS Item M0100) equal to 01 (SOC), 03 (ROC) or 04 (Recertification)

Tip: Get the M0090 date right! Remember that M0090 is usually technically NOT the date of assessment. Although, the time period does not include the quality checks, it does include the time it takes to complete best practices. For example, the patient has a medication issue that needs to be reported to the physician and the physician does not respond until the next day. That next day is the M0090 date. Another example: The physician is called for orders for best practices like falls risk, pain mitigation or diabetic foot assessment and care and confirms three days later the orders for those best practices. M0090 is that date, not the actual SOC visit date.

Warning: Medicare managed care plans also require an OASIS to be submitted for each episode and agencies have been denied ALL claims on ADRs because they have not submitted the OASIS.

Best Tip: Behind in your quality checks of OASIS assessments? Selman-Holman CoDR—Coding Done Right can help you catch up and keep up, and ensure accuracy and completeness in a timely manner. Contact Linda@selmanholman.com for more information.

You may also want to review MLN Matters Article MM9585, which is available at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNMattersArticles/Downloads/mm9585.pdf.