Archive for April, 2017

April 18, 2017

Sweet News for Diabetes with Ketoacidosis and More

Sweet News for Diabetes with Ketoacidosis and More

CMS released its proposed list of new codes on Friday, April 14th as part of the physician payment rule. Significant for home health and hospice: New codes for Type 2 diabetes with ketoacidosis and more choices for non-pressure ulcers!

We’ll have to continue coding E13.10 (per Coding Clinic) for our type 2 diabetics with ketoacidosis until October 1, then we will switch to:

E11.10- Type 2 diabetes mellitus with ketoacidosis without coma

Requests were sent for new codes for non-pressure ulcers (L97 and L98) last year. We were concerned that the codes with 6th characters 3 and 4 required muscle necrosis or bone necrosis, which are difficult for clinicians to determine. Clinicians need to do a better job at describing the structures seen, when documenting non-pressure ulcers, so that the 6th character 9 for unspecified can be avoided. New 6th characters 5 and 6 indicate muscle involvement without necrosis and bone involvement without necrosis. We also have been provided codes for ‘other specified severity’ (6th character 8) for when the description by the clinician or the physician doesn’t match up with the other descriptions of severity.

 

New code lists are just part 1 of the coding changes. Coding nerds also look forward to changes in the tabular list, alphabetical index and the coding guidelines. A whole summer of fun for coding nerds!

L97.105-Non-pressure chronic ulcer of unspecified thigh with muscle involvement without evidence of necrosis

L97.106-Non-pressure chronic ulcer of unspecified thigh with bone involvement without evidence of necrosis

L97.108-Non-pressure chronic ulcer of unspecified thigh with other specified severity

L97.115-Non-pressure chronic ulcer of right thigh with muscle involvement without evidence of necrosis

L97.116-Non-pressure chronic ulcer of right thigh with bone involvement without evidence of necrosis

L97.118-Non-pressure chronic ulcer of right thigh with other specified severity

L97.125-Non-pressure chronic ulcer of left thigh with muscle involvement without evidence of necrosis

L97.126-Non-pressure chronic ulcer of left thigh with bone involvement without evidence of necrosis

L97.128-Non-pressure chronic ulcer of left thigh with other specified severity

L97.205-Non-pressure chronic ulcer of unspecified calf with muscle involvement without evidence of necrosis

L97.206-Non-pressure chronic ulcer of unspecified calf with bone involvement without evidence of necrosis

L97.208-Non-pressure chronic ulcer of unspecified calf with other specified severity

L97.215-Non-pressure chronic ulcer of right calf with muscle involvement without evidence of necrosis

L97.216-Non-pressure chronic ulcer of right calf with bone involvement without evidence of necrosis

L97.218-Non-pressure chronic ulcer of right calf with other specified severity

L97.225-Non-pressure chronic ulcer of left calf with muscle involvement without evidence of necrosis

L97.226-Non-pressure chronic ulcer of left calf with bone involvement without evidence of necrosis

L97.228-Non-pressure chronic ulcer of left calf with other specified severity

L97.305-Non-pressure chronic ulcer of unspecified ankle with muscle involvement without evidence of necrosis

L97.306-Non-pressure chronic ulcer of unspecified ankle with bone involvement without evidence of necrosis

L97.308-Non-pressure chronic ulcer of unspecified ankle with other specified severity

L97.315-Non-pressure chronic ulcer of right ankle with muscle involvement without evidence of necrosis

L97.316-Non-pressure chronic ulcer of right ankle with bone involvement without evidence of necrosis

L97.318-Non-pressure chronic ulcer of right ankle with other specified severity

L97.325-Non-pressure chronic ulcer of left ankle with muscle involvement without evidence of necrosis

L97.326-Non-pressure chronic ulcer of left ankle with bone involvement without evidence of necrosis

L97.328-Non-pressure chronic ulcer of left ankle with other specified severity

L97.405-Non-pressure chronic ulcer of unspecified heel and midfoot with muscle involvement without evidence of necrosis

L97.406-Non-pressure chronic ulcer of unspecified heel and midfoot with bone involvement without evidence of necrosis

L97.408-Non-pressure chronic ulcer of unspecified heel and midfoot with other specified severity

L97.415-Non-pressure chronic ulcer of right heel and midfoot with muscle involvement without evidence of necrosis

L97.416-Non-pressure chronic ulcer of right heel and midfoot with bone involvement without evidence of necrosis

L97.418-Non-pressure chronic ulcer of right heel and midfoot with other specified severity

L97.425-Non-pressure chronic ulcer of left heel and midfoot with muscle involvement without evidence of necrosis

L97.426-Non-pressure chronic ulcer of left heel and midfoot with bone involvement without evidence of necrosis

L97.428-Non-pressure chronic ulcer of left heel and midfoot with other specified severity

L97.505-Non-pressure chronic ulcer of other part of unspecified foot with muscle involvement without evidence of necrosis

L97.506-Non-pressure chronic ulcer of other part of unspecified foot with bone involvement without evidence of necrosis

L97.508-Non-pressure chronic ulcer of other part of unspecified foot with other specified severity

L97.515-Non-pressure chronic ulcer of other part of right foot with muscle involvement without evidence of necrosis

L97.516-Non-pressure chronic ulcer of other part of right foot with bone involvement without evidence of necrosis

L97.518-Non-pressure chronic ulcer of other part of right foot with other specified severity

L97.525-Non-pressure chronic ulcer of other part of left foot with muscle involvement without evidence of necrosis

L97.526-Non-pressure chronic ulcer of other part of left foot with bone involvement without evidence of necrosis

L97.528-Non-pressure chronic ulcer of other part of left foot with other specified severity

L97.805-Non-pressure chronic ulcer of other part of unspecified lower leg with muscle involvement without evidence of necrosis

L97.806-Non-pressure chronic ulcer of other part of unspecified lower leg with bone involvement without evidence of necrosis

L97.808-Non-pressure chronic ulcer of other part of unspecified lower leg with other specified severity

L97.815-Non-pressure chronic ulcer of other part of right lower leg with muscle involvement without evidence of necrosis

L97.816-Non-pressure chronic ulcer of other part of right lower leg with bone involvement without evidence of necrosis

L97.818-Non-pressure chronic ulcer of other part of right lower leg with other specified severity

L97.825-Non-pressure chronic ulcer of other part of left lower leg with muscle involvement without evidence of necrosis

L97.826-Non-pressure chronic ulcer of other part of left lower leg with bone involvement without evidence of necrosis

L97.828-Non-pressure chronic ulcer of other part of left lower leg with other specified severity

L97.905-Non-pressure chronic ulcer of unspecified part of unspecified lower leg with muscle involvement without evidence of necrosis

L97.906-Non-pressure chronic ulcer of unspecified part of unspecified lower leg with bone involvement without evidence of necrosis

L97.908-Non-pressure chronic ulcer of unspecified part of unspecified lower leg with other specified severity

L97.915-Non-pressure chronic ulcer of unspecified part of right lower leg with muscle involvement without evidence of necrosis

L97.916-Non-pressure chronic ulcer of unspecified part of right lower leg with bone involvement without evidence of necrosis

L97.918-Non-pressure chronic ulcer of unspecified part of right lower leg with other specified severity

L97.925-Non-pressure chronic ulcer of unspecified part of left lower leg with muscle involvement without evidence of necrosis

L97.926-Non-pressure chronic ulcer of unspecified part of left lower leg with bone involvement without evidence of necrosis

L97.928-Non-pressure chronic ulcer of unspecified part of left lower leg with other specified severity

L98.415-Non-pressure chronic ulcer of buttock with muscle involvement without evidence of necrosis

L98.416-Non-pressure chronic ulcer of buttock with bone involvement without evidence of necrosis

L98.418-Non-pressure chronic ulcer of buttock with other specified severity

L98.425-Non-pressure chronic ulcer of back with muscle involvement without evidence of necrosis

L98.426-Non-pressure chronic ulcer of back with bone involvement without evidence of necrosis

L98.428-Non-pressure chronic ulcer of back with other specified severity

L98.495-Non-pressure chronic ulcer of other sites with muscle involvement without evidence of necrosis

L98.496-Non-pressure chronic ulcer of other sites with bone involvement without evidence of necrosis

L98.498-Non-pressure chronic ulcer of other sites with other specified severity

 

Here is a link to the complete list of new codes.

2018 Proposed Codes

April 12, 2017

Another Way for Them to Take Your Money (Part 2)

Mary Carr at NAHC provides the following information regarding submitting the OASIS prior to claim that I want to share with you.
The edit is not intended to enforce the 30 day OASIS submission time frame.  The edit is checking  that an OASIS has been  submitted prior to the claim and that the HIPPS codes match. The edit is on claims with dates of service after April 1, 2017

When a claim is submitted the edit will look to see if the OASIS is in the system.

  • If the OASIS is present the claim will pay, regardless of whether or not  the OASIS was submitted within 30 days of the M0090 in accord with §484. 55.
  •  If the OASIS is not present, the edit will look to see if the date between M0090 and the date the claim was submitted is greater than 40 days. If these two conditions exist  the claim will deny.    

 

CMS is providing 40 days as a look back period since  agencies are provided  30 days to submit the OASIS and to accommodate any lag time that might occur when a claim and an OASIS  are submitted close to the 30 day time frame.    

 

The OASIS submission date changes in the QIES system with each OASIS modification and submission. However, since the edit is not enforcing the OASIS submission time frame requirement, modifications to the OASIS should not  cause a claim to deny, unless the correction requires an inactivation or deletion of the OASIS and the replacement OASIS is not entered prior to a claim submission.  There could be a small window where corrections to the OASIS could change the OASIS submission date to a date later than the claim submission date prior to the claim processing. We are checking with CMS for clarification on the implications for OASIS corrections and claim submissions.

 

At any rate, agencies should review and retain their validation reports to demonstrate that the OASIS associated with the claim was submitted prior to the claim.

 

Lisa Selman-Holman
Selman-Holman & Associates,LLC
CoDR–Coding Done Right