Archive for November, 2010

November 29, 2010

A comorbidity quandry? No, look at treatment and patient health

I continue to receive questions on hypertension (401.9) and pulmonary hypertension (416.0). One reader recently asked if I would consider pulmonary hypertension to be a comorbidity that should always be coded.

Remember that the list of comorbidities “that should always be coded” are examples of diagnoses likely to impact care because of the chronicity. When you code a comorbidity … a condition that affects the patient’s health, or is such an impactful disease that even if it is under control can affect the patient’s health detrimentally and quickly … that you must think about the treatment aspect.

Is pulmonary hypertension under treatment with medications, education, or intervention? Yes, code it. Does pulmonary hypertension have the potential of impacting other conditions? Probably, but remember that CMS requires that comorbidities be addressed in the POC, so what are you doing about the pulmonary hypertension?

Keep in mind that “chronic” does not automatically mean that a disease is a comorbidity. GERD (530.81) is a great example. A patient may have chronic GERD, but if medication has taken care of symptoms for a length of time, what justifies its “status” as a comorbidity? It’s not being treated by home health professionals. There aren’t interventions.

I love this question … someone is thinking on their feet!

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November 24, 2010

Don’t code yourself for Thanksgiving!

Watch yourself this Thanksgiving, or you might become the subject of an E code:

E015.1: Injury due to activities: grilling and smoking food


E015.2: Injury due to activities: cooking and baking

Enjoy yourselves, but not too much. I don’t want anyone with 787.01, 787.02, 787.03, or worse yet, 787.3 from eating too much.

We at Selman-Holman & Associates and CoDR thank you for your continued patronage and wish you a Happy Thanksgiving!
Eternal blessings!!

November 23, 2010

Physicians must date and sign certs, recerts

This information comes from the National Association for Home Care and Hospice:

Effective Jan. 1, 2011, all Medicare home health and hospice certifications and recertifications must be not only signed by the ordering physician, but also must be dated by that physician. During a conference call last week, the Centers for Medicare & Medicaid Services (CMS) advised its contractors of this interpretation of the final rule updating the home health prospective payment system for 2011 that was published in the Nov. 17 Federal Register.

According to CMS, this change will be effective for all claims submitted on or after Jan. 1, 2011. CMS referenced current policy manual citations, new home health regulations, and existing hospice regulations and manual citations as the basis for its authority. However, CMS failed to reference longstanding policy found in the home health plan of care instructions that permits fixing the date of receipt of signed orders in lieu of physicians dating their signatures.

The Medicare General Information, Eligibility and Entitlement Manual (Pub. 100-01), Chapter 4, section 30.1 states: “The attending physician signs and dates the POC/certification prior to the claim being submitted for payment.”

Hospices are referred to policy and regulations for physician dates of their signature in the CMS online manual Medicare General Information, Eligibility and Entitlement Manual (Pub. 100-01), Chapter 4, section 60, which states: “Certification statements must be dated and signed by the physician.” And the regulation in the November 17 Federal Register 42CFR 418.22 (b)(5) effective Jan. 1, 2011 states: “All certifications and re-certifications must be signed and dated by the physician(s).”

November 23, 2010

OASIS claims payment reference is here!

On Oct. 20, I posted about how OASIS claims are required for payment. I have received several queries about where the source information can be found. Look below for the answers!

The Federal Register, November 2009 ( explains: “Rather, we intend that in finalizing this policy, providers will ensure that prior to submitting a final HH PPS episode claim, a provider will have submitted an OASIS, and the HIPPS code on the final HH PPS episode claim will be consistent with the HIPPS on the OASIS validation report. As such, we are implementing the provision to require the submission of OASIS for final claims as a condition of payment, and revising § 484.210”

This pertains to HH PPS claims and Medicare HMOs will most likely have their own requirements.
This information comes from Category 1 Question 1 from CMS(updated 09/09):The comprehensive assessment must include OASIS items for all skilled Medicare, Medicaid, and Medicare or Medicaid managed care patients with the following exceptions: patients under the age of 18, patients receiving maternity services, patients receiving only chore or housekeeping services, and patients receiving only a single visit in a quality episode. The transmission requirement currently applies to Medicare and Medicaid patients receiving skilled care only.

November 18, 2010

Consider a patient’s safety in performing ADL tasks, not just the ability to perform them

I recently heard from an agency with this patient: He has end-stage COPD with dyspnea on almost all ADL’s, even on 3 liters/minute of oxygen.  His O2 saturation remains at 96-98% even when having significant dyspnea, as long as he remains on O2.

He lives with his son and is alone during the day.  He is able to do his own grooming, make his lunch, transfer on-off his toilet  and walk in the home without a device.  He is, however, very S.O.B. doing these things. Breathing, however, is not considered for things like toilet transfer.

Is he scored as being able to do these items independently?

It is important to remember that the ADL questions include the patient’s safety in performing the tasks, not whether he has the ability to perform the tasks. Dyspnea doesn’t necessarily make the patient unable to perform the task safely. On the other hand, if the patient becomes so dyspneic that he collapses, that would indicate he is unsafe. The questions also do not consider efficiency. For example, if he has to take rest breaks during the tasks, those rest breaks do not impact the scoring. The rest breaks actually may increase the safety.

Remember to consider safety as you rate your patients.