Posts tagged ‘M1010’

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.

October 29, 2010

Look beyond payment with M1016 and ROC

I wanted to clarify the use of M1016 when you’re changing diagnosis codes at a resumption of care. In this circumstance, would you change the codes in M1016 at recertification or just keep an eye on it?

Part of the answer is looking at when you use OASIS slots with the ROC.

Diagnosis codes at the ROC are placed in M1010, M1016 and M1020/1022/1024 as appropriate.

The other part of the answer lies in looking at the overall impact your ROC may have, not just the payment impact.

Although coding at ROC does not impact your payment (except if the ROC is performed in the last 5 days of the episode) it does impact you risk adjustment on your outcomes.

Because of that impact, it is important to update your codes as necessary at ROC.

October 9, 2010

Place diagnoses in M1010 when treatment goes beyond standard medications

CMS has given guidance on when to list inpatient diagnoses, M1010, and the agency specifically answers the question of whether giving medicines is “active treatment.”

Question:

If a patient is hospitalized (or in a SNF) and is given his/her routine medications BUT some of those medications are for diagnoses that are not the reason for the hospitalization, are the diagnoses for which the routine meds are given considered as being “treated” during the stay. For example: the patient is admitted to the hospital for surgery. While in the hospital, he is given his routine medication for HTN, atrial fib, GERD, etc. Should those dx be listed at M1010?

CMS answer:

When completing M1010, Inpatient Diagnoses, only include the diagnoses actively treated during the inpatient facility stay within the past 14 days, not all the diagnoses the patient may have. “Actively treated” should be defined as receiving something more than the regularly scheduled medications and treatments necessary to maintain or treat an existing condition. In the scenario you provided, Hypertension would not be included in M1010 if the patient only received their maintenance dose of antihypertensive.

Here is the site reference to the April 2010 Q&As.

September 9, 2010

Rehab facility status is key to answering M1010, M1012, M1016

Are rehabilitation facilities considered inpatient settings? That is the key to answering M1010, M1012 and M1016 correctly if you patient comes from such a facility.

Let’s say a patient is discharged from a hospital on Sept. 1 and goes to a rehab facility and isn’t discharged from their until Sept 24. SOC is Sept. 25.

How should M1010 (inpatient diagnosis), M1012 (inpatient procedures) and M1016 (regimen change) be answered?

The key is to remember that a rehab facility is an inpatient facility (see M1000), so the diagnoses treated there would pertain to M1010 and M1016. Procedures would not be performed at a rehab facility, so M1012 wouldn’t apply.