Posts tagged ‘ICD-9 Home Health Coding’

September 30, 2010

Watch your “with”

Code changes happen tomorrow … doesn’t Oct. 1 always sneak up on us?

To look at my overview of the changes, just go to my Musings-of-a-Codeaholic page!

Along with code changes have come some guideline changes, and I want to remind everyone what CMS is now saying about “with”:

“The word “with” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List.

“The word “with” in the alphabetic index is sequenced immediately following

the main term, not in alphabetical order.”

The bolded text is the part that takes effect Oct. 1 This should eliminate a lot of confusion over relationships with this important preposition.

Looking for guidelines? Look no further!

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August 24, 2010

Confusion over case mix and 781.2? No.

Question: People were overusing 781.2, and then the criteria changed on how to capture case mix points: You also needed and ulcer and/or IV therapy. Is this still the criteria?

Lisa says: The criteria haven’t changed since January 2008.  Abnormality of gait is still case mix, but does not receive points unless the patient also has a pressure ulcer, it’s an early episode and there are less than 14 therapy visits. (See row 19 of CMS’s Table 4 for the official cite.)

Infusion therapy has never been part of the criteria for 781.2. Always remember that you code for medical necessity and services provided, NOT case mix.

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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August 12, 2010

2011 code thoughts

Go to the Musings of a Code-a-holic page to see my thoughts on the Oct. 1 changes!

August 5, 2010

When are PT/INRs considered skilled care?

There is a lot of confusion over skilled care when it comes to venipuncture ….

Venipuncture is considered a skill, just not a qualifying skill. Most likely you are performing observation and assessment of the condition that requires an anticoagulant. If performing the PT/INR by one of the machines, it is still a skill.

To code correctly, code the condition, then V58.83 (Encounter for therapeutic monitoring of medications), and V58.61 (Long term use of anticoagulants).