Archive for June, 2011

June 30, 2011

New codes quiz time

It’s that time of year … the final new code lists are out, and we need to start learning. Here are some fill-in-the-blank to help you learn new codes: (Answers at the bottom)

1. Look up this main term to see changes to 416.8

2. You should use one or two additional codes (if you have documentation) with this new Infection of cystostomy code

3. Category 539 deals with complications of these procedures

4. Acquired absence of a joint now has this subcategory

5. Several codes, including chronic pulmonary embolism (416.2) and pulmonary embolism and infarction (415.1) now have excludes notes for these types of codes

6. Other infections with the central _____ catheter has new codes

7. This code now deals with aggressive behavior in dementia

8. Influenza codes in categories 487 and ___ have gotten more specific

9. *Local* infection due to central venous catheter is coded here

10. This chapter received a new title this year

11. There are more than 10 new codes and 20 revisions for this eye disease

12. NCHS’s correction addendum swapped out V54.81 with V54.82 when coding this V58 subcategory

13. V40.31, Wandering in diseases classified elsewhere, excludes Alzheimer’s and this symptom often association with Alzheimer’s

14. Complications codes are getting more complicated. Don’t code 596.8x with this urinary complications code

15. When coding some atherosclerosis codes, watch the use additional code note on some codes in this category

16. Pelvic fractures (808.5x) now have specificity for open or ______

17. This phrase is now used to describe the previously known “mental retardation”

18. For skin cancer codes, a fifth-digit of 2 designates squamous cell _____

More to come on new codes, but if you’re looking for the complete Index and Tabular listings, as well as the errata, go to this NCHS list.


1. hypertension; 2. 596.81; 3. bariatric; 4. V88.2; 5. personal history; 6. venous; 7. 294.21; 8. 488; 9. 999.93; 10. five; 11. glaucoma; 12. V58.9; 13. dementia; 14. 997.5; 15. 707; 16. closed; 17. intellectual disabilities; 18. carcinoma

June 21, 2011

Miami nurse convicted of health care fraud and false statements regarding health care matters

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation, Miami Field Office, and Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Office of Investigations, Miami Regional Office, announced that a federal jury in Miami found Armando Santos, of Miami, guilty of health care fraud and making false statements related to health care matters. After a three-day trial, the jury convicted Santos today of one count of conspiracy to commit health care fraud, in violation of Title 18, United States Code, Section 1349; four counts of health care fraud, in violation of Title 18, United States Code, Section 1347, and two counts of false statements related to health care matters, in violation of Title 18, United States Code, Section 1035.

Sentencing will be scheduled in August 2011 before Chief U.S. District Judge Federico Moreno. Santos faces a statutory maximum of 10 years’ imprisonment as to each of the fraud charges, and five years imprisonment as to each of the false statement charges.

According to the evidence presented at trial, Santos was a registered nurse employed by a Miami-Dade based home health care agency. As part of his job as a home health nurse, Santos was paid to provide skilled nursing services to Medicare beneficiaries that were homebound, diabetic, insulin dependent, and so ill that they were unable to inject themselves with insulin.

Under Medicare regulations, Santos was required to keep records of each time he provided a skilled nursing service to a Medicare beneficiary. Between June 27, 2007, and March 13, 2009, Santos completed hundreds of documents in which he claimed that he had injected Medicare beneficiaries with insulin two times a day, seven days per week.

At trial, however, the evidence showed that at least two of the Medicare beneficiaries that the defendant claimed to be injecting with insulin twice daily, seven days per week, were neither in need of insulin nor homebound. The evidence also showed that the defendant claimed to be treating two separate Medicare beneficiaries at the same time. The defendant’s false statements resulted in the submission of $230,315 in false claims to Medicare for services that were either not medically necessary or actually provided to Medicare beneficiaries.

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case was prosecuted by Assistant U.S. Attorneys H. Ron Davidson and Michael O’Leary.

A copy of this press release may be found on the website of the United States Attorney’s Office for the Southern District of Florida at Related court documents and information may be found on the website of the District Court for the Southern District of Florida at or on

June 17, 2011

NAHC begins face-to-face survey … let’s help!

NAHC is conducting a nationwide physician survey regarding  face-to-face home health requirements. NAHC will be meeting with Medicare soon regarding face-to-face and wants to have as much data as possible.

The survey is attached here and the survey deadline is June 24.

Here is the survey:


June 16, 2011

Acute codes belong in home health

We usually think of acute diseases as being those treated outside of home health, but is that always the case? What if you have a patient who is still in an acute phase, and has been admitted with acute pancreatitis? Can it go in M1020?

In general, pancreatitis not resolved is probably acute. It is entirely correct to code acute conditions in home health when they still exist. Many codes, in fact, include a guideline stating to code as acute unless the physician documents chronic. The statement that home health cannot take care of acute patients is entirely incorrect.

This is a statement from the Medicare Benefit Policy Manual regarding skilled nursing:
The determination of whether a patient needs skilled nursing care should be based solely upon the patient’s unique condition and individual needs, without regard to whether the illness or injury is acute, chronic, terminal, or expected to extend over a long period of time. In addition, skilled care may, depending on the unique condition of the patient, continue to be necessary for patients whose condition is stable.

June 15, 2011

Test Your Version 5010 Implementation Efforts Today!

The Version 5010 compliance deadline of January 1, 2012, is nearly six months away!  All HIPAA-covered entities should be preparing for this transition, which includes conducting external testing with all trading partners (providers, clearinghouses, and vendors) to ensure timely compliance.
To assist with testing, the Centers for Medicare & Medicaid Services (CMS), in conjunction with the Medicare Fee-for-Service (FFS) Program, is holding two National 5010 Testing Days. The testing days will serve as an opportunity for trading partners to further test compliance efforts with the added benefit of live help desk support, and direct and immediate access to Medicare Administrative Contractors (MACs). 

The first National Version 5010 Testing Day is today, June 15, 2011. The other testing day is scheduled for August 24, 2011. We hope all trading partners will participate so that they can have a timely and smooth transition to Version 5010!
These testing days will help facilitate a better understanding of MAC testing protocols and the transition to Version 5010; they are not meant to prohibit trading partners from further compliance testing. All trading partners are encouraged to begin working with their MACS to test transactions as soon as possible.

Keep Up to Date on Version 5010 and ICD-10.
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