Archive for August, 2010

August 24, 2010

Confusion over case mix and 781.2? No.

Question: People were overusing 781.2, and then the criteria changed on how to capture case mix points: You also needed and ulcer and/or IV therapy. Is this still the criteria?

Lisa says: The criteria haven’t changed since January 2008.  Abnormality of gait is still case mix, but does not receive points unless the patient also has a pressure ulcer, it’s an early episode and there are less than 14 therapy visits. (See row 19 of CMS’s Table 4 for the official cite.)

Infusion therapy has never been part of the criteria for 781.2. Always remember that you code for medical necessity and services provided, NOT case mix.

August 23, 2010

M1240 … a pain to get right?

Pain is such a subjective subject, and I’ve heard from many clinicians who wonder how to answer M1240 correctly … does it refer only to severe pain? When does pain qualify? So let’s look at the question, then at ways to assess.

M1240: Has the patient had a formal pain assessment using a standardized pain assessment tool (appropriate to the patient’s ability to communicate the severity of pain)?
0: No standardized assessment conducted
1: Yes, and it does not indicate severe pain
2: Yes, and it indicates severe pain

The OASIS Guidance Manual tells us that this item’s intent is to see if a standardized assessment was conducted, and what the level of pain was, if, and only if, the assessment was conducted.

The item’s intent deals with the assessment, and CMS has stated that clinicians should assess for “any and all pain the patient experiences.” (April 2010)

When dealing with M1240, watch M2250 (Plan of Care Synopsis) and M2400 (Intervention Synopsis).

M2250 is where it would be noted if the doctor ordered interventions and monitoring for the pain. Only mark NA if the patient is not experiencing pain. (That’s NO PAIN AT ALL.)

August 18, 2010

2011 Guidelines Clarify V07, ‘With’ and some CVA

2011 Coding Guidelines have been updated, and there are very few additions to the Guidelines. I am still scanning for any deletions (which are not noted by CMS). Here, first, are some additions to watch:

In the Conventions section, there is a clarification of “with” when used in the Tabular List and Index. With “should be interpreted to mean ‘associated with’ or
‘due to.'”

There are two notes at CVA. Neither applies to home health, but I’ll write about them because CVA is such a watched (and miscoded) diagnosis.

One note at CVA talks about coding neurologic deficits regardless of whether they resolve prior to discharge. Remember that this applies to acute discharge, not home health.

The second note states that 438 codes are for late effects of cerebrovascular disease (which we know, because we use this code category, note 434), not for neurologic deficits associated with an acute CVA. This simply confirms that 438 codes are for post-acute settings, such as home health. There are no code change implications for home health, and this guidance goes along with 3rd Quarter 2009 Coding Clinic guidance where even resolved deficits are code in acute settings, even if resolved at discharge.

V codes always have changes, and there is a general clarification of what Status codes are, with new guidelines stating that these are …. codes that show a patient is a carrier of a disease, has the sequelae or residual or has another factor influencing health.

Following the changes to the Tabular List, the guidelines now indicate that V07 is appropriate for prophylactic or treatment measures.

Those are the main additions … I’ll post more if there are other changes or deletions I find out about.

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August 17, 2010

M1012: Use judgment on relevant procedures

We’re still feeling our way around M1012, and CMS has given some guidance on relevant inpatient procedures. In its July Q&As, CMS addressed it in this way

Question: If a patient’s inpatient diagnosis was a Hemorrhagic Bleed, should the CT Scan of Brain be considered a procedure relevant to the home health plan of care and be reported in M1012 – Inpatient Procedures?

CMS answer: A diagnostic procedure that confirmed a diagnosis that is addressed in the home health plan of care is relevant and would be reported in M1012 – Inpatient Procedures. Assessing clinicians need to use their judgment in determining if a procedure is relevant to the home health plan of care.

Looking for all of the July questions and answers?

August 13, 2010

M0090, M1350, and M2004 questions answered

Here are answers to three recent questions that I have fielded on OASIS:

For M0090, we’ve heard that is the date that we  (RNs) complete the OASIS assessment, including getting frequency from PT, OT, ST, and response from MD if any abnormalities with meds are found … this occurs all in a five-day window. Others are teaching to put the M0o90 date as the date we (RNs) complete the assessments without info from others. How do we fill this item?

Lisa says: The assessing clinician has six days to complete the SOC assessment.  (Assessment is day zero + five days.) This time period includes collaboration with other clinicians, i.e., M2200, and waiting for the physician’s response for M2250. M0090 is the date the assessment is completed, and it is not complete until that info has been received.

If you address a wound under Wound 1 in M1350, do you answer as a ‘yes’? Or does this question only apply to the previous questions about ulcers. If you have a PICC line that you address later in the SOC, do you answer M1350 as ‘yes’?

Lisa says: M1350 includes any wounds or skin lesions OTHER than the pressure ulcers, stasis ulcers, surgical wounds already addressed, and bowel ostomies, which are also addressed in another item. The answer ‘yes’ on M1350 means that the skin lesion or wound requires intervention and assessment. PICC lines that require intervention ARE included.

Let’s say that the SOC and DC OASIS are all that were completed when answering M2004. You answered it as ‘no’ on the SOC because you did not receive a response from the MD in 24 hours, you have addressed all issues, and no new issues have appeared. Do you answer this as ‘NA’ or ‘no’ if the MD did not respond in the 24 hours from the SOC OASIS?
Lisa says: If the physician does not respond within one calendar day (which can be longer than 24 hours, given the way CMS has defined it) the answer has to be ‘no’ on M2004. If there were no issues identified, then ‘NA’ would be the correct answer. Keep alert to news on this, as some recent CMS guidance could muddy this answer.

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