Archive for September, 2010

September 30, 2010

Watch your “with”

Code changes happen tomorrow … doesn’t Oct. 1 always sneak up on us?

To look at my overview of the changes, just go to my Musings-of-a-Codeaholic page!

Along with code changes have come some guideline changes, and I want to remind everyone what CMS is now saying about “with”:

“The word “with” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List.

“The word “with” in the alphabetic index is sequenced immediately following

the main term, not in alphabetical order.”

The bolded text is the part that takes effect Oct. 1 This should eliminate a lot of confusion over relationships with this important preposition.

Looking for guidelines? Look no further!

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September 28, 2010

Straight up surgical wound guidance

I get many questions on venous devices and whether they are current surgical wound … Here is CMS’s official guidance.

From CMS: An implanted venous access device is considered a current surgical wound as long as it is implanted in the patient’s body. When first implanted, the incision is the surgical wound. The assessing clinician will follow the 12/09 WOCN guidance to determine the healing status of the incision. Once it is fully epithelialized, the site due to the implanted device will remain a current surgical wound with a status of “Newly epithelialized” for as long as it is present in the patient’s body, unless it later develops complications.

Looking for the official guidance? Look at CMS’s OASIS Q&A, Category 4b, Q105.3.

September 23, 2010

You can use new codes Sept. 26-29 … read on

Every year, we worry about new codes, but we start to panic about when to start billilng with them … it’s not as simple as Oct. 1!

I’ve been corresponding with CMS on this issue, and here is the current, correct, information.

I started by simply asking if the effective date for using new and changed codes is based on M0090 or based on episode start dates?

  • In the past, it was based on episode start dates.
  • Last year, CMS announced via the home care forum that the effective date is based on M0090.

An expert at CMS stated that the “HH Grouper validates ICD-9 codes based on the M0090 date.” He added that there is a billing instruction (only one): That the diagnosis codes on the RAP match the codes in M1020 and M1022.

Actually, he typed in “M0230 and M0240,” so I followed up asking if the manual had been updated to OASIS-C. He said it would be shortly.

What about episodes that span Oct. 1?

CMS said that Medicare “allows either year’s Dx codes on RAPs or claims that span 10/1.” The reason this can happen is that there is a documented bypass for our type of billing (it you want to read the regs, just click below and go to p.27). The bypass also means that 2011 codes can be used Sept. 26-Sept. 29!

Here is the short of the bypass, and a link to the full document:

The bypass is documented in the IOCE specs, on p.27:

7) Bypass diagnosis edits (1-5) for bill types 32x and 33x (HHA) &12x (inpt/B) if From date is before October 1 and Through date is on or after October 1. And for bill types 322 & 332 if From date is between 9/26 and 9/30, inclusive.

Still looking for new codes education! Order a CD of my 90-minute education that dealt with coding, RTP, billing, and trend issues to be aware of!

September 21, 2010

Correct pressure ulcer terminology will stop errors in M1320

Correct documentation, and wording in that documentation, are crucial to correct OASIS and coding. Pressure ulcers have very specific wordings, and using the incorrect phrase with a certain stage ulcer can result in rejection or validation errors as you electronically submit your records.

Let’s say this is your documentation:
M1308: a. Stage II, Number present: 2
M1320: 1- Fully Granulating
There is a note from the nurse that the ulcer is not “not healing,” so 03 on M1320 is ruled out by the agency.
Submitting this will result in a validation error on M1320. Why? Because Stage II pressure ulcers do not granulate. According to WOCN guidelines, if no granulation tissue is present, then the ulcer is not healing. If the RN is, indeed, seeing red beefy tissue (granulation) then the ulcer is likely to be at least a Stage III. OASIS does not allow any answer other than ‘not healing’ on Stage IIs.
Watch the WOCN website (linked on this blog) for definitions and pressure ulcer policy … and make sure to read your OASIS manual well for guidance!

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September 19, 2010

CMS updates home health quality manuals

A new week, and CMS has some updates to some home-health focused manuals on its website:

The new Process Based Quality Improvement (PBQI) Manual can be downloaded at

The revised, updated Outcome Based Quality Improvement (OBQI) Manual can be downloaded at

The revised, updated Outcome Based Quality Management (OBQM) Manual can be downloaded at

Also, as a reminder, the OASIS-C Guidance Manual and recently released errata can be downloaded at