Posts tagged ‘official coding guidelines’

September 7, 2012

Use official guidance to help with symptom coding

Symptom coding is always confusing!

Should I code abnormality of gait for example if my patient has hemiplegia? What about if she’s falling and the physician doesn’t have an explanation for the falls yet?

If you have the DecisionHealth 2012 Complete Home Health ICD-9-CM Diagnosis Coding Manual turn to p. 1039 and read the second paragraph. Some of those examples do not apply to home care but it is a good summary of when we do use symptom codes. The part about integral or not is in the general coding guidelines p.29 #6-8. That should help you think about whether you need abnormality of gait, difficulty walking or any other symptom!!

By the way, those symptom codes are not required just because you’re adding therapy to the mix. There is no separate set of rules when it comes to coding for therapy in home care!

If you don’t have that particular coding manual, it’s still in your book, because it’s official guidance! For other manuals, look at the first page of Chapter 16 (780-799) and the Official Guidelines for Coding and Reporting, Section I.B.6-8.

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!!

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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