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November 24, 2010

Don’t code yourself for Thanksgiving!

Watch yourself this Thanksgiving, or you might become the subject of an E code:

E015.1: Injury due to activities: grilling and smoking food


E015.2: Injury due to activities: cooking and baking

Enjoy yourselves, but not too much. I don’t want anyone with 787.01, 787.02, 787.03, or worse yet, 787.3 from eating too much.

We at Selman-Holman & Associates and CoDR thank you for your continued patronage and wish you a Happy Thanksgiving!
Eternal blessings!!

November 5, 2010

An example of clinicians doing the skilled visit and comprehensive assessment

I posted late Tuesday on clinicians doing a skilled visit and the comprehensive assessment. I’ve received several requests for an example, so here you go!

A referral on a patient requires a visit at 10pm to administer an IV antibiotic. An RN can make the visit at 10pm, providing the skillled care and performing the initial assessment (determine immediate care needs and homebound status). That visit qualifies as the SOC because a reimbursable service was provided. Another RN can make a visit the next day (or within 5 days after the SOC) to complete the OASIS comprehensive assessment.

November 2, 2010

Separate clinicians can do SOC OASIS and ‘first visit’

It seems that many agencies believe that the SOC OASIS needs to be done by the same clinician who did the first visit, but that’s not true.

The initial assessment does not have to done by the same person who does the comprehensive assessment. Most times, it is the same person because both assessments are completed during the same visit, but the CoPs allow for the initial assessment  being performed at a different visit.

Remember that if nursing is involved in the POC, an RN must conduct both assessments. In some instances, it may be a therapy only case, the therapist may complete the initial assessment and the RN may visit on the same day or within five days after the therapist’s visit to complete the comprehensive assessment.

October 29, 2010

V53.99 is not a wound VAC code

A treat today … no tricks. Another clarification on wound VAC coding …

I’ve posted several pressure ulcer/wound VAC answers lately (look in the archives of this blog, or click on the keywords at the bottom of this post!) Here’s another one that I hope gets us to better coding:

Question: May we use the aftercare code of V53.99 to capture the use of the VAC?
Lisa says: V53.99 is fitting and adjustment of other device and is very non-specific. There is no specific code for wound VACs. Also consider that most wounds that require a wound VAC are complicated wounds, so what does that mean about using a V code?

You DON’T use V codes for complicated codes.

The wound VAC is simply a wound dressing, so IF a V code is appropriate, use V58.30 or V58.31. If the wound is complicated, then just code the wound. I do not recommend the use of V53.99 for wound vacs.

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.