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!

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