Archive for April, 2013

April 18, 2013

Coding Mysteries Exposed

Coding Mysteries Exposed…


It seems that coding myths of all sorts have been running rampant lately among home health coders, both those related to the ICD-9-CM and ICD-10-CM code sets. Coders, don’t believe everything you hear, especially if it doesn’t make sense or seems to conflict with official coding guidelines. Even software scrubbers and edits can cause confusion within agencies when it comes to the assignment of codes, resulting in serious misunderstandings and potential claim errors.


Here is some clarity on a few of these myths and rumors:


#1)Hypertension coding- Since the change in case mix points to hypertension codes in January 2012, agencies and coders seem to be increasingly confused on how to use these codes. First of all, let’s clear the air on the rumor that “401.X codes are no longer valid codes.” They sure are! This rumor originates from the removal of case mix points for the 401.X codes, as well as the fact that many agencies have received ADRs after using these codes as primary diagnoses on their claims. Coders and other home health professionals need to know that these codes are still valid and need to be used appropriately. The cause for ADRs and other medical reviews on claims with these codes as primary relates to the use of hypertension as a primary diagnosis for multiple episodes. CMS is inquiring as to whether or not these patient’s are truly unstable, or if agencies are just monitoring blood pressures for multiple episodes. Second, coding for hypertensive heart disease (402.XX) does not presume a relationship between the hypertension and heart disease. In order to use this code, the physician absolutely must state that there is a causal relationship present between the heart disease and hypertension. Furthermore, take note that only certain cardiac conditions are classified under hypertensive heart disease (402.XX), and that this does not include many conditions such as coronary artery disease.


#2) Diabetes as a primary diagnosis- the popularity of many software edits and OASIS scrubber systems has created a whole new wave of challenges for agencies and caused coders to second guess their skills. Many software systems will report an edit that Diabetes (250.00) should not be coded as a primary, as (according to the incorrect software warning) the code indicates the diabetes is “stable”. However, this is a complete falsehood and terribly misleading guidance. 250.XX indicates the diagnosis of diabetes. The fourth digit “0” indicates the physician indicated no manifestations. The fifth digit “0” indicates that the physician did not diagnose the diabetes as uncontrolled or out of controlled. Under no circumstances does the code 250.00 indicate stable Diabetes. However, agencies and coders are being misled by poorly phrased software edits. While its important only to use Diabetes without mention of complications, and not stated as uncontrolled (250.00) as a primary diagnosis when the clinical record indicates it, there is no coding guidance or regulation preventing its use.


These two misunderstandings can cause serious problems for home health coders, not to mention creating claim errors for agencies as well. As we make the transition to the ICD-10-CM code set, coders are going to need to be even more cautious in keeping their eyes and ears open for these coding falsehoods. In order to help combat some of these perplexing untruths and keep coders on the right track, we will be frequently posting here on Home Health Insight some of the more commonly encountered coding myths. Please feel free to submit your coding myth, mystery, or question to us!


Brandi Whitemyer, Guest Blogger, Senior Associate, Selman-Holman & Associates, LLC and CoDR—Coding Done Right


Are you ready for ICD-10-CM? Those attending my classes feel more confident and ready for a smooth transition. Testing claims in ICD-10-CM began April 1. Please join me in Baton Rouge April 25, Mission May 23 or San Antonio on June 26.   Check for information. Lisa

April 8, 2013

You can’t assess what you can’t see!

Guest Blogger-Brandi Whitemyer, RN, HCS-D, HCS-O, COS-C, AHIMA Approved ICD-10-CM Trainer/Ambassador, Senior Associate


You can’t assess what you can’t see!

When assessing your patients, its important to remember that you can’t assess what isn’t there! For example, how often is it that you arrive to perform a start of care or resumption of care assessment and your patient has yet to pick up their medications from the pharmacy? Every home health clinician knows the line, “I have the scripts, I just don’t have all of them yet”, or, “I can’t afford those until Tuesday.” But how do you assess a patient’s ability to take all of their medications safely and reliably all of the time, when they only have some of their medications?


Well, CMS says you can’t! M2020, Management of Oral Medications, is an OASIS item frequently missed by clinicians due to a simple misunderstanding of OASIS-C guidance. Here is what CMS has to say (Q& A- January, 2011):


Question: If the patient does not have her prescribed medications in the home because she cannot afford them and she does not plan on getting them, what is the most appropriate response for M2020?

Answer: When completing M2020, Management of Oral Medications, you are reporting the patient’s ability to take all oral medications reliably and safely at all times on the day of the assessment. If the patient did not take her medications on the day of the assessment because they were not present in the home, you cannot make assumptions about a patient’s ability to take medications she doesn’t have. If the medications were not in the home, you would not be able to determine if she could take each medication at the correct time and dose. The patient’s status would be reported as “3-Unable to take medications unless administered by another person”.

So, if your patient does not have the ordered medications in the home, you as the assessing clinician, obviously cannot make any judgment as to how the patient is able to take his or her medications safely and reliably at all times and must respond “3.” Just keep in mind that patient compliance and willingness does not get taken into consideration. If your patient does not have his or her medications because he or she has no intention of taking them or refuses to pick them up because he or she does not ever take them, then you would not consider this in your response.

Similarly, when responding to OASIS items such as M1860 (Ambulation/Locomotion), if the patient is determined to only ambulate safely with the assistance of a device, but does not have any assistive device in the home (note: holding onto walls and furniture does not count as “assistive device” when assessing!), then you will need to respond “3” (“able to walk only with the supervision or assistance of another person at all times”) to M1860, Ambulation/Locomotion, (CMS Q& As Cat. 4b-Q155.1) Again, you cannot determine the patient’s safe ability to use a device that he or she does not have!

Selman-Holman & Associates, LLC and CoDR—Coding Done Right provides customized education for your agency on OASIS issues, as well as OASIS review. Call us at 214-550-1477 or send an email to

Guest Blogger: Brandi Whitemyer, RN, HCS-D, HCS-O, COS-C, AHIMA Approved ICD-10-CM Trainer/Ambassador, Senior Associate

April 1, 2013

ICD-10 Readiness and Timeline

Guest Blogger-Brandi Whitemyer, RN, HCS-D, HCS-O, COS-C, AHIMA Approved ICD-10-CM Trainer/Ambassador, Senior Associate


Ready or Not-

Get ready! Believe it or not, ICD-10 is coming. It seems that many out there remain skeptics on this subject, but CMS has made it clear since the August 24, 2012 final rule announcement that the October 1st, 2014 implementation date is set in stone. The Acting Administrator of CMS announced just last week that October 1, 2014 IS THE BIG DAY and there will be NO further delays! ICD-10 is tied to HIPAA regulation; so all providers will be required to comply with the transition. Fortunately, CMS has provided a timeline with suggested practices during the pre-implementation period to assist agencies in preparing for this looming deadline.


Here is what they have to say:


  • Immediately- begin reviewing ICD-10 resources, making staff aware of the upcoming change, and identifying needs for process change within your agency. Design and develop your agency’s ICD-10 implementation plan and assign those responsible. Inquire with vendors and payers regarding their ICD-10 readiness.


  • Spring 2013 through fall 2014- Begin the process of training at your agency. (Keep in mind that due to the extent of change involved you will need to train staff at all levels from field staff to billing to coding to administration.) At this time, staff responsible for coding should be assessed for readiness and trainability to transition to ICD-10. Staff directly involved in the coding process for your agency should begin training for the ICD-10 code set. Clinical and coding staff should all be involved in training to review specific areas that will impact performance on ICD-10, including documentation and anatomy & physiology.


  • October 2013 through January, 2014-CMS is recommending that agencies begin submitting test claims for ICD-10 by October 2013. NGS has been contracted to assist in the submission of test claims for home health. The process of test claim submission can assist in early detection of problem areas, as well as assist agencies in identification of process improvement needs prior to the required October 1st, 2014 implementation date.


  • Spring 2014- Review your agency’s implementation plan for appropriateness and any needed changes. Review preparation of coding and clinical staff and assure the implementation of detailed training no later than 6-9 months prior to the October, 2014 implementation date (9 months recommended). Define vendor readiness and assure systems will be ready for implementation deadline. This is also the time period that we should have information from CMS about grouper changes.


  • October 1st, 2014- full compliance deadline. All services on or before September 31st, 2014 will be coded using the ICD-9 code set. All services initiated on or after October 1st, 2014 will be coded using the ICD-10 code set.


The bottom line is that we are on the fast track to ICD-10 and there is no turning back now! Don’t let your agency fall behind with so much to do in the next 17 months. Selman-Holman & Associates, CoDR—Coding Done Right, and its team of AHIMA Approved ICD-10 Trainers/Ambassadors are ready to help your agency with creating the perfect, seamless ICD-10 transition plan for success!


Call 214-550-1477 or email for more information!