Posts tagged ‘case-mix’

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 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.

September 5, 2012

OASIS training comes to Grapevine!

I’m bringing my one-day OASIS training to Grapevine, Texas, on Oct. 12!!

Achieve OASIS-C accuracy, improve case-mix and outcomes scores, and receive full and prompt reimbursement by attending this full-day intermediate-level OASIS-C training course.

Work through interactive patient scenarios updated with the latest from CMS
including new wound guidance.

Learn to:

  • Receive full reimbursement with tips for answering key case-mix items
  • Improve outcome scores with clues for navigating the nuances of related items
  • Get assessment and intervention strategies for answering OASIS-C process items
  • Avoid ADRs and denials
  • Bonus: Use this class to prepare for the HCS-O certification exam.

Learn more and register!

July 9, 2012

401.9 is still valid … just not case-mix

I recently received a query on hypertension codes. A client was saying that 401.9 and 401.0 are no longer legitimate, as of January 2012, but coding books ordered after that have these codes.

My response is below:

The coding manual is correct. The codes are valid codes. The coding guidelines have not changed on using 401.9 and 401.1. If the patient has hypertension and there is 1) no stated or implied relationship documented by the physician between the hypertension and heart failure and 2) no chronic kidney disease or renal sclerosis, then the 401 category is correct for hypertension.

Furthermore, if the 401 category is correct (as is usual), then 4th digit 9 (unspecified) is usually correct because the physician doesn’t specify benign or malignant.

What did change is the case-mix status of 401.9 and 401.1. Those two codes are no longer case mix meaning they do not earn points. But alas, do not be discouraged. Many patients who have hypertension also have CAD, chronic ischemia, heart failure or the like, and those diagnoses earn the same points that 401.9 and 401.1 used to earn.

Continue to code hypertension when it is pertinent to your POC. The codes ARE allowed. What is important is to NOT change the code you use for HTN just to get points. CMS is looking for that type of behavior.

The coding manuals were published prior to the final rule from CMS on case-mix status so all you’ll need to do to update your manual is to write “NO $” next to those two codes.

 

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December 5, 2011

OASIS Tour is up and running

It’s not too late to sign up for my OASIS: Strategies for Success seminars!

We’re touring in:

Dec. 5-6: Houston

Dec. 13-14: Dallas

Dec.15-16: McAllen

This is beyond basics. Here are some highlights of what we will focus on:

 

  • What OASIS is used for, and why accurate and consistent assessment really matters
  • How to score OASIS items on a Start of Care assessment
  • Techniques to improve assessment accuracy and speed
  • How responses to individual OASIS items impact your agency’s reimbursement, OBQI outcome scores, and OBQM avoidable events
  • How the new risk adjustment model works, and how your clinicians’ OASIS responses shape your agency’s case mix profile and outcomes
  • How to put all the pieces together to improve care delivery and quality outcomes

Learn more and register!