Posts tagged ‘cva’

January 18, 2011

You cannot keep a patient for PT/INR only

Question: Is it possible to keep a patient for home health only to perform PT/INR labs. Initially we received this patient for CVA. She currently is stable but still requires therapeutic drug monitoring. Every other disease process is stable and been taught on. Is therapeutic drug monitoring a valid reason, and can it be the only reason why we continue to have the patient on board?

Lisa says: Venipuncture is a skill but not a qualifying skill for Medicare home health. A patient such as you described is usually receiving observation and assessment as the skill. Observation and assessment is considered a skill only if there is a potentially fluctuating condition. If there have been no changes, then O and A probably is no longer skilled.

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December 5, 2010

CVA, V12.54 and Hemiplegia

There seem to be some lingering questions from guidance of a few months ago. This issue is one that never seems to  go away: CVA.In the past, the Coding Clinic had instructed hospitals not to code hemiplegia in acute CVA patients if the hemiplegia had resolved before discharge. (Q2, 1989) A question in the Q2 2009 Coding Clinic asked for reconsideration of this policy, given the significance of the diagnosis and the fact that many patients may be receiving therapy, even though the diagnosis is resolved.

This should not affect home health coding, given we cannot use acute codes in M1020 or M1022. We use late effects. Three codes deal with hemiplegia …

438.20, Hemiplegia affecting unspecified side
438.21, Hemiplegia affecting dominant side
438.22, Hemiplegia affecting nondominant side
We should be able to continue to code these for our therapy patients.

This change should not affect V12.54, history of TIA/CVA. Since all the deficits are resolved before our patients get to us, there are no late effects to deal with. We can still code acute stroke in M1010 and M1016 provided within 14 days.

August 18, 2010

2011 Guidelines Clarify V07, ‘With’ and some CVA

2011 Coding Guidelines have been updated, and there are very few additions to the Guidelines. I am still scanning for any deletions (which are not noted by CMS). Here, first, are some additions to watch:

In the Conventions section, there is a clarification of “with” when used in the Tabular List and Index. With “should be interpreted to mean ‘associated with’ or
‘due to.'”

There are two notes at CVA. Neither applies to home health, but I’ll write about them because CVA is such a watched (and miscoded) diagnosis.

One note at CVA talks about coding neurologic deficits regardless of whether they resolve prior to discharge. Remember that this applies to acute discharge, not home health.

The second note states that 438 codes are for late effects of cerebrovascular disease (which we know, because we use this code category, note 434), not for neurologic deficits associated with an acute CVA. This simply confirms that 438 codes are for post-acute settings, such as home health. There are no code change implications for home health, and this guidance goes along with 3rd Quarter 2009 Coding Clinic guidance where even resolved deficits are code in acute settings, even if resolved at discharge.

V codes always have changes, and there is a general clarification of what Status codes are, with new guidelines stating that these are …. codes that show a patient is a carrier of a disease, has the sequelae or residual or has another factor influencing health.

Following the changes to the Tabular List, the guidelines now indicate that V07 is appropriate for prophylactic or treatment measures.

Those are the main additions … I’ll post more if there are other changes or deletions I find out about.

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