Posts tagged ‘M1024’

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.”

January 24, 2011

OASIS Q&As deal with pressure ulcers and surgical wounds

A new set of OASIS Q&As has been posted through the OCCB website.

M1020, M1022, M1024 do not get any mention, but there are several clarifications regarding wounds, and M1012 gets a nod, as well. Below are some highlights, and the link to the full set of Q&As.

Question 3: For M1012, Inpatient Procedure, can the same relevant procedure be listed twice if the procedure was done on two different dates in the inpatient facility?
Answer 3: Currently, there would be no reason or benefit to listing a procedure more than once.

Question 8: If you have two Stage IV pressure ulcers with intact skin in-between them and a tunnel that connects them underneath the wound surface, do you have one pressure ulcer or two?
Answer 8: If a patient develops two pressure ulcers that are separated by intact skin but have a tunnel which connects the two, they remain two pressure ulcers.

Question 9: When sutures are removed from surgical wounds healing by primary intention, how does it affect the healing status of the wound?
Answer 9: For the purposes of scoring the OASIS item, M1342, Status of the Most Problematic (Observable) Surgical Wound, openings in the skin, adjacent to the incision line, caused by the removal of a staple or suture, are not to be considered part of the surgical wound when determining the status of the surgical wound. The status of these sites would be included in the comprehensive assessment clinical documentation.
When determining the healing status of the incision, follow the WOCN Guidance on OASIS-C Integumentary Items, in addition to other relevant current CMS Q&As. The status of “not healing” would only be selected if the wound, excluding the status of the staple/suture site(s), meets the WOCN descriptors.

Other topics in the Q&As:

  • Influenza vaccine
  • M1300, risk of pressure ulcers
  • Explainer of “performing other ADLs” in M1400, dyspnea
  • UTIs
  • Impaired decision-making
  • M1840 and transferring … and lots more.

Looking for the Q&As?

January 10, 2011

There’s more to coding than case mix

There is more to coding than case mix, folks.

I receive this type of question all … the … time …

Do I put a case mix code in M1024 if the V code in M1020 or M1022 is not on the list of “approved” codes that trigger the Grouper to calculate case mix?

The answer I give all … the … time … Yes, code it. That code can impact risk adjustment.

So let’s step back and look at an example.

Your patient has recently resolved breast cancer (174.9), so you code V10.3 in M1022. Do you code 174.9 in M1024?

In this scenario, it’s resolved, so it’s not eligible for M1022.

According to CMS’s Grouper Software, V10 is not on approved list of V codes that triggers the Grouper to check M1024 for potential reimbursement. So do you code 174.9 in M1024 when there won’t be reimbursement for it?

I say yes. There is more to coding that reimbursement. There is painting an accurate picture of the patient’s health, and there is risk adjustment. That cancer has played a significant role in the current state of the patient’s health … why wouldn’t you code it? You can gain risk adjustment, which would impact your outcomes scores and accurately show the acuity of your patient population … why wouldn’t you code it?

I know there are other experts who disagree with my assessment, but until CMS comes out with a rule that says you do not code in M1024 when that V code in M1020 or M1022 does not trigger the Grouper to look for case-mix, I will continue to code that disease for all of the reasons listed above.

As you code, keep coding by services provided and patient care in mind. Your V10.3 may not be in the top six diagnoses. At that point, case-mix and risk adjustment become moot, but the coding of the history of cancer does not. If the breast cancer was significantly impacting care and other disease processes, that V10.3 may be in the top six diagnoses. The Official Coding Guidelines also indicate that the history of malignant neoplasm codes should be used when the cancer has been eradicated and requires no further treatment.

This all could change of course, because CMS is working on changing the OASIS treatment authorization code to include the case mix diagnoses in M1024. We’re all used to change being in home health!!

January 5, 2011

Is debridement a surgical wound?

Question: If my patient had a debridement, can I mark 1 (Yes, patient has at least one (observable) surgical wound) in M1340?

Lisa says: No, debridement is not a surgical treatment, and CMS clearly states this in its M1340 specific instructions: Debridement or the placement of a skin graft does not create a surgical wound, as these are treatments performed to an existing wound. The wound would continue to be defined as the type of wound previously identified.

However, debridement is a place where OASIS and coding may not always match up. For example, you can code V58.77, Aftercare of surgery of the skin and subcutaneous tissue, NEC, in some cases. For example, for a patient with a debrided diabetic ulcer of the elbow, you can code V58.77 in M1020, and then code 250.80, 707.1x in M1024. The V58.77 code as primary indicates that the focus of care is a wound that is resolving without complications and considering the complexity and chronicity of diabetic ulcers, the V58.77 code is likely not the best choice.

IF V58.77 is used, remember that as a Diabetes case-mix diagnosis, 250.80 and 707.1x can go in both M1024 and M1022, if active. This is still active, of course, so code in M1022.

Just because M1340 isn’t applicable doesn’t mean that you should forget your OASIS … M1350 includes any wounds or skin lesions OTHER than the pressure ulcers, stasis ulcers, surgical wounds already addressed, and bowel ostomies, which are also addressed in another item. The answer ‘yes’ on M1350 means that the skin lesion or wound requires intervention and assessment.
December 7, 2010

Coding education in Vegas does not stay in Vegas!

Go back to your agency as a coder or administrator and share the information you learned at the Coding and Regulatory Symposium! Come to my two-day class focusing on recent coding changes, especially those impacting wounds and therapy, with a focus on regulations and how these changes impact the bottom-line of agencies.

January 27-28, 2011, Monte Carlo Resort and Casino in Las Vegas, Nevada
9:00AM -4:15PM each day

This class is appropriate for all levels of coders, plus administrators who want to learn more about how coding impacts revenues and operations.

Agenda Day 1

Morning focus: Regulatory Issues
9:00‐10:00  How Coding and OASIS Add to Your Case Mix Score
10:00‐10:45  Myths and Truths that Impact Therapy Coding
10:45‐11:00 Break
11:00‐11:30 Common Errors Impacting Your Payment and Outcomes
11:30‐12:00 ICD‐10 and the 2011 Change to the 5010 Format
12:00‐1:00 Lunch
Afternoon focus: Applying regulatory education to coding
1:00‐2:00  Sequencing and Coding Guidelines
2:00‐2:45  Interactive Coding Session
2:45‐3:00 Break
3:00‐4:15 Interactive Coding Session (continued)
4:15  Adjournment
Agenda Day 2
9:00‐10:30 Wound Care Coding: All Wrapped Up
10:30‐10:45 Break
10:45‐12:00 Interactive Coding Session
12:00‐1:00 Lunch
1:00‐2:30 How Jan. 1 PPS Changes Impact your Operations
2:30‐2:45 Break
2:45‐3:30 How to Support Your Coding and Appeal Downcoding
3:30‐4:15 Facts and Forward Thinking about ICD‐10‐CM and ICD‐10‐PCS
4:15 Adjournment

Coming to Vegas?

$49 a night! That’s the price we have arranged (plus $12.95 for a resort fee) for each night at the Monte Carlo!!

Looking for a registration form?