Archive for November, 2012

November 28, 2012

It’s The End of the World as We Know It (Or Why M1024 Will Change Home Health)

There’s a lot of hype about the world ending in 2012. I don’t believe that, but it reminds me of an REM song & M1024—“It’s The End of the World as We Know It.”

Why? M1024 and its predecessors, M0245 and M0246 have been a part of our home health coding world since 2003 when we started using V codes in our coding. Medicare’s final rule for PPS 2013 limits the use of M1024 to only one particular instance for payment diagnoses beginning Jan. 1, and the plan is to decimate it all together once ICD-10-CM is ushered in Oct. 1, 2014. I applaud deleting M1024 from the OASIS, but I desire a different outcome with the remnants of M1024.

M1024 will be used for fractures only beginning in January. Medicare, in a surprise move, stated that resolved conditions do not belong in M1024 and we shouldn’t have been earning points there. CMS reports that the change will be minimal to our case mix scoring, however other sources report that as many as 60% of our assessments include resolved case mix diagnoses in M1024—that will mean a drop in our payment.

We can still get primary points for diabetes, Neuro 1 and Skin 1 case mix diagnoses if we sequence correctly without using M1024 according to Medicare’s grouper change. But, there is one frequently used method for coding that can mean the end of those points if coders are not careful (less points = less money for those who need it spelled out).

I have a short recording on the change to M1024 that will be posted on my website soon and do not miss the opportunity for more in-depth instruction on the change and its impact in upcoming classes in Dallas and Corpus Christi in December. Check my website for details.

So, it’s the end of the world as we know it. It remains to be seen if we’ll “feel fine.”

November 20, 2012

Communicating ICD-10 to payers

CMS is offering more advice and information on the ICD-10 transition. This focuses on talking to your payers:

As you prepare for ICD-10, check with your payers to be sure they are moving forward with ICD-10 planning. You will want to work together to ensure you meet the ICD-10 deadline – October 1, 2014.

Here are some questions to ask your payers:

  • Are you prepared to meet the ICD-10 deadline of October 1, 2014? Where is your organization in the transition process?
  • Who will be my primary contact at your organization for the ICD-10 transition?
  • Can we set up regular check-in meetings to keep our progress on track?
  • When will you be ready to accept test transactions from my practice?
  • What will we need to test with you?
  • Do you anticipate any changes in policies or delays in payments to result from the switch to ICD-10?

CMS’s ICD-10 website

November 16, 2012

Nephrostomy tubes are response 2 on M1018

A clarification from CMS on M1018 and nephrostomy tubes …

Question: When answering M1018, if client has a nephrostomy tube do you mark indwelling/suprapubic catheter?
Answer from CMS: If the nephrostomy tube is utilized for urinary drainage, it is an indwelling
catheter, therefore Response 2 – Indwelling/suprapubic catheter would be selected.
See more Q&As.

November 13, 2012

Readmissions rise without HH support

From FierceHealthcare:

New research adds even more fuel to the fire, in which some providers argue they face unfair financial penalties for readmissions outside of their control, with social factors affecting patients returning to the hospital.

According to a new study in the October-December Advances in Nursing Science journal, elderly patients who lacked support in a home health setting after a hospital stay fared worse than those who had a solid support system for self-care.

Hong Tao, assistant professor at University of Wisconsin Milwaukee College of Nursing, and other researchers found that a “self-care deficit” in the elderly post-hospitalization population correlated to bouncing back to the hospital, according to yesterday’s research announcement. Patients’ living arrangements, such as whether they lived alone or had a family member as a primary informal caregiver, as well as the frequency of care and the type of care provided, were all related to readmissions.
Researchers also found that the patients’ age, obesity, lower levels of cognitive functioning also were linked to the self-care deficit.

“Patients who received more care were more likely to have a better functional ability,” study authors wrote.
Out of the more than 1,200 elderly home healthcare patients studied, about 21 percent were rehospitalized within 60 days of being released from the hospital to home care; most of those people were back in the hospital in less than 20 days.

With 1 in every 4 patients discharged from hospital to home health being rehospitalized, national readmissions stood at a steady 29 percent in 2008, compared to 28 percent in 2004, according to the study.

Researchers noted the takeaway for providers is to improve social environmental support for the patients but also improve help for the informal caregivers.

“Caregivers of these patients may benefit from additional resources to help them manage the tiring physical demands of their patients,” they wrote. “… Those patients who received environmental support from their caregivers in the form of psychosocial support, facilitating access to medical care or serving as a financial and/or health agent, tended to benefit, function at a higher level and have less potential for rehospitalization.”

November 11, 2012

Once again: 401.9 is a valid code

I have received another email from someone who attended my class asking me to verify that 401.9 is a valid code … others at her agency are telling her that it is not a valid hypertension code.

It is. 401.9 is valid. It is a useful code and one that you may have to use, depending on documentation.

401.9 is a valid code and is the correct code for HTN when no other information is available. It would be upcoding to change your hypertension code if you did not have additional information. There are many codes that we use that do not provide points, and this code is no longer case-mix. We must code according to the patient’s condition and the coding guidelines regardless whether the code is case-mix. Remember that if the patient has a heart condition, such as acute MI, chronic insufficiency, CAD or heart failure, then you’ve still earned those points that used to be awarded for 401.9.