Archive for January, 2011

January 31, 2011

Be aware of glaucoma coding

Today is glaucoma awareness day, so let’s take a quick look at this eye disease.

The basics: Increased introcular pressure causes optic nerve damage and loss of vision, beginning with peripheral vision. Early stages of glaucoma do not have symptoms.

Most glaucomas are in Category 365, except for congenital glaucoma (743.20-743.22) and absolute glaucoma (360.42).

Two years ago, CMS removed the manifestation status of all glaucomas except 365.44, Glaucoma associated with systemic syndromes. This code is used when glaucoma is a manifestation of diabetes, as well as several other diseases.

In these cases, make sure to code the diabetes or other underlying disease first.

For congenital glaucoma, it must be documented by the physician.

January 30, 2011

CMS clarifies PPS considerations

Does any of this sound familiar?

What do I do when:

  • A patient in a new 60-day episode is discharged with all goals
    met but the patient returns to the same HHA during the 60-day episode. (PEP Adjustment applies)
  • I have a patient with a qualifying inpatient stay who returns to the agency during the last 5 days of an episode  (days 56-60).
  • My patient’s inpatient stay extends beyond the end of the current certification period. … and other such timing and care quandries?

CMS released in December and just recently updated its OASIS Considerations for PPS. This document deals with common problems, which RFA to work with, how to think about M0100 and M2200, and also has links to the Claims manual where you can find more information.

It is worth more than one look!

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January 26, 2011

Number of diabetics continues to rise

The CDC just came out with new figures on diabetes in the United States:

More than 26 million Americans now have the disease, and about one-third of adults have prediabetes.

Check out the CDC page.

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January 24, 2011

OASIS Q&As deal with pressure ulcers and surgical wounds

A new set of OASIS Q&As has been posted through the OCCB website.

M1020, M1022, M1024 do not get any mention, but there are several clarifications regarding wounds, and M1012 gets a nod, as well. Below are some highlights, and the link to the full set of Q&As.

M1012
Question 3: For M1012, Inpatient Procedure, can the same relevant procedure be listed twice if the procedure was done on two different dates in the inpatient facility?
Answer 3: Currently, there would be no reason or benefit to listing a procedure more than once.

M1306
Question 8: If you have two Stage IV pressure ulcers with intact skin in-between them and a tunnel that connects them underneath the wound surface, do you have one pressure ulcer or two?
Answer 8: If a patient develops two pressure ulcers that are separated by intact skin but have a tunnel which connects the two, they remain two pressure ulcers.

M1342
Question 9: When sutures are removed from surgical wounds healing by primary intention, how does it affect the healing status of the wound?
Answer 9: For the purposes of scoring the OASIS item, M1342, Status of the Most Problematic (Observable) Surgical Wound, openings in the skin, adjacent to the incision line, caused by the removal of a staple or suture, are not to be considered part of the surgical wound when determining the status of the surgical wound. The status of these sites would be included in the comprehensive assessment clinical documentation.
When determining the healing status of the incision, follow the WOCN Guidance on OASIS-C Integumentary Items, in addition to other relevant current CMS Q&As. The status of “not healing” would only be selected if the wound, excluding the status of the staple/suture site(s), meets the WOCN descriptors.

Other topics in the Q&As:

  • Influenza vaccine
  • M1300, risk of pressure ulcers
  • Explainer of “performing other ADLs” in M1400, dyspnea
  • UTIs
  • Impaired decision-making
  • M1840 and transferring … and lots more.

Looking for the Q&As?

January 24, 2011

Chime in on falls prevention

The U.S. Preventive Services Task Force is inviting public comment on its draft recommendation statement on the prevention of falls in older adults.

There are multiple parts of the draft, including clinical considerations and recommendations to prevent falls: physical therapy (of course!) and vitamin D.

With 30-40 percent of Americans over the age of 65 having fallen in the past year, we need to chime in!

The opportunity to comment on this draft recommendation statement is available until February 9.