Archive for April, 2011

April 26, 2011

Major improvement or decline require a follow-up assessment

Question: Let’s say that I did a recert on 4/11/2011 and then the patient had an outpatient mastectomy 4/12/2011.  I went to see her on 4/13/2011, which was the first day of her recert. Would this visit be considered a SCIC or can we do as a regular visit and a telephone order for the orders of the mastectomy care?

Lisa says: A follow-up assessment is required for a major improvement or decline in condition, but your policy defines  major improvement or decline. You must complete another follow-up assessment if the circumstances meet your policy. 

April 18, 2011

Learn a little ICD-10: Musculoskeletal

ICD-10 seems so far away, and we shouldn’t learn specific coding information until it gets closer to transition time. However, knowing the basics of ICD-10 and what will change can be useful for us all.

AHIMA has begun to run educational overviews on ICD-10 codes. This month’s education focuses on the musculoskeletal system.

ICD-10 addresses the musculoskeletal system in Chapter 13: Disease of the Musculoskeletal and Connective Tissue (M00-M99) and Chapter 19: Injury, Poisoning, and Certain Consequences of External Causes (S00-T88) (to replace current Chapter 17 items).

These chapters identify the episode of care, give more specifics on fractures and injuries and add osteoporosis instructions.

See this month’s on the musculoskeletal system, which also includes specifics on:

  • site and laterality;
  • moved codes;
  • detail;
  • injuries and fractures;
  • osteopeorosis
April 15, 2011

Place those case-mix codes on the POC

Just a reminder that all resolved case-mix codes, not just active codes, need to be on the POC.

Because CMS may pay case-mix for these codes, they need to be put in the POC, but not in Fields 11 and 13 of the 485 … those are for active illnesses/disease.

There isn’t an “official” spot to put these codes, but I like Field 21.

April 14, 2011

Take action soon on CAHABA transition

Something for all Cahaba agencies to note:
Notice for Agencies Affected by J15 MAC Transition from Cahaba to CIGNA
Who: This notice is for home health and hospice providers in Colorado, Delaware, Iowa, Kansas, Maryland, Missouri, Montana, Nebraska, North Dakota, Pennsylvania, South Dakota, Utah, Virginia, West Virginia, Wyoming, and the District of Columbia as well as any other home health or hospice provider, regardless of state, that is currently billing to Cahaba GBA.
What: If your current home health or hospice Medicare contractor is Cahaba GBA, you must take action in preparation for the J15 Medicare Administrative Contractor (MAC) cutover date from Cahaba to CIGNA Government Services which is set for June 13, 2011. In order to ensure smooth transition of Medicare payments, you must complete an electronic funds transfer (EFT) re-enrollment. Without a proper electronic funds transfer re-enrollment with CGS at the cutover date, Medicare payments will cease.
Takeaway: CIGNA’s key message to providers is that i f home health or hospice providers are currently enrolled with Cahaba to receive their Medicare reimbursement electronically, they MUST complete an EFT authorization with CIGNA Government Services and submit it along with either an original voided check or bank letter. They need only complete the EFT authorization at the “Group PTAN” level. The CIGNA Government Services website for this process is There, providers can access Web-based training on how to complete the EFT re-enrollment, the EFT application itself, and complete instructions for submitting it to CIGNA Government Services. Providers that need to follow up on the status of a previously submitted EFT application may call the J15 Implementation Helpdesk at (877) 819-7109.

April 11, 2011

PT scope of practice is probably larger than you think

I often hear from clinicians frustrated that PTs won’t do this or that … maybe for good reasons, and maybe not. And I hear from PTs who just don’t know what their scope of work should be.

If you want to know the PT scope of practice, just go to the Benefit Policy Manual. In Chapter 7 you will find the General Principles Governing Reasonable and Necessary Physical Therapy, Speech-Language Pathology Services, and Occupational Therapy sections in 40.2.1- of the Benefit Policy Manual.

CMS provides examples of the type of work in the scope of practice, including assessment, wound care, teaching, and other issues.