Look beyond payment with M1016 and ROC

I wanted to clarify the use of M1016 when you’re changing diagnosis codes at a resumption of care. In this circumstance, would you change the codes in M1016 at recertification or just keep an eye on it?

Part of the answer is looking at when you use OASIS slots with the ROC.

Diagnosis codes at the ROC are placed in M1010, M1016 and M1020/1022/1024 as appropriate.

The other part of the answer lies in looking at the overall impact your ROC may have, not just the payment impact.

Although coding at ROC does not impact your payment (except if the ROC is performed in the last 5 days of the episode) it does impact you risk adjustment on your outcomes.

Because of that impact, it is important to update your codes as necessary at ROC.

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