Home Health Insight

Tables from Pseudocode

2008-01-12T15:14:00Z

These are the tables from the pseudocode, including Table 4, the list of V codes that have potential underlying case mix codes. Click here to download this Microsoft Excell File.

Coding Crossword Puzzle

2007-02-24T21:38:00Z

Download this free crossword puzzle and put your ICD-9 knowledge to the test. Participants preparing for the BAMC ICD-9 exam can also use this to help study. Click here to download the puzzle.

New Diagnosis Consultation Form

2006-10-16T23:39:00Z

The following link will direct you to a new tool that may prove useful to you and your agency. It was provided to Selman Holman and Associates by Justine R. Byington, HCS-D. Permission has been granted to anyone who would like to use, enhance, edit and share. You will need a copy of Microsoft Word to open this file.

http://selmanholman.com/DIAGNOSIS%20CONSULTATION%20FORM.doc

Official Coding Guidelines December 1, 2005 Change How We Look At Therapy

2006-09-16T01:46:00Z

Official Coding Guidelines December 1, 2005 Change How We Look At Therapy

Official Coding Guidelines to coincide with changes to the codes that were effective October 1, 2005 were published on November 21 and were effective December 1, 2005. Although there is additional information in the guidelines regarding some of the new codes that may provide additional insight into coding, the most significant of the changes impacting home health care are the changes to the V Code Table. The Official Coding Guidelines are not in your 2006 book, unless your publisher sent you updated pages to replace those in the book.

The V Code Table indicates which V codes may be first listed or primary; either first or additional (primary or secondary); and additional only (secondary only). Although there are several changes, only those changes that impact home health care will be discussed.

Keep in mind that V codes indicate a reason for encounter. The usual situations that V codes are used in home care include when “a person with a resolving disease or injury, or a chronic, long term condition requiring continuous care, encounters the health care system for specific aftercare of that disease or injury... A diagnosis/symptom code should be used whenever a current, acute, diagnosis is being treated…” (Official Coding Guidelines, Effective December 1, 2005, page 47 or 77) V codes are also used in home care when “circumstances or problems influence a person’s health status but are not in themselves a current illness or injury.” (ibid p. 48 of 77)

V57 Care involving use of rehabilitation procedures

The code category V57 has been moved from the “First or Additional” list to the “First Listed” list. This means that V57 codes may be placed in M0230 only. V57 codes may not be placed in M0240. This change does NOT mean that anytime therapy is provided, that the appropriate V57 code must be coded as primary. Guidelines for selecting the primary diagnosis and sequencing still apply.

If only rehabilitation services are being provided for a resolving disease or injury, or a chronic, long-term condition requiring continuous care then the appropriate V57 will be coded as primary. If a current, acute diagnosis is being treated then that diagnosis should be coded as primary. In that case, according to the Guidelines, the V57 codes would not be coded at all.

This is the change that impacts home care the most. The change is good for a number of reasons. First, risk adjustment is not impacted by V codes so the “freeing up” of M0240 spots for other numerical diagnoses will help to improve the risk adjustment on the diagnoses and possibly impact the outcomes. Second, coders will have to think harder and make better decisions on whether V57 should be primary (it is now primary 25% of the time which is out of sync with what should be happening).

What impact will this change have on billing? It should have no impact. The Regional Home Health Intermediaries (RHHI) will still know when therapy has been provided by the revenue codes and visits logged on the final claim. The HIPPS code contains an ‘L’ or an ‘M’ in the 4^th position when the therapy threshold has been met.

Home care agencies will probably increase the use of V57.89 multiple training or therapy. In the past, some coders have resisted the use of V57.89 because it took away the specificity of coding all the therapies. Now that we can code the V57 codes in M0230 only, if we are providing more than one therapy, then we will be more likely to use V57.89 as primary.

This change affects the entire category of V57 for physical therapy, occupational therapy and speech therapy, in addition to multiple therapies.

Examples:

The patient is receiving physical therapy only after a fracture to the hip. V57.1 would be coded as primary.

The patient is receiving PT, OT and nursing after a joint replacement. V54.81 would be coded as primary, followed by the appropriate V43.6x code to indicate the joint. V57.1, V57.21 and V57.89 would not be coded at all.

If nursing and therapy are both caring for the patient, don’t count the number of visits to determine “who” will be first. Instead, look at the conditions being treated and code the most acute condition requiring the most intensive services. Choose the condition that reflects the chief reason for home care; not the V57 code.

V58.6 Long term (current) drug use

The V58.6x codes are now secondary only. These codes have always been considered status codes so this change may not be a surprise to many. The code means the patient is taking the drug, not that the provider is doing anything with it, so it should not be coded as primary.

The Guidelines provide some additional information about the use of this code. They state on page 50 of 77: “Assign a code from subcategory V58.6, Long-term (current) drug use, if the patient is receiving a medication for an extended period as a prophylactic measure (such as for the prevention of deep vein thrombosis) or as treatment of a chronic condition (such as arthritis) or a disease requiring a lengthy course of treatment (such as cancer). Do not assign a code from subcategory V58.6 for medication being administered for a brief period of time to treat an acute illness or injury (such as a course of antibiotics to treat acute bronchitis).”

This guidance may not be the clarification you need, but remember this if your patient will take the medication for an extended period of time or is taking it prophylactically, perhaps you should code the code. Ask yourself: “Is it clinically logical to code it?”

V15.88 History of Fall (at risk for falling)

Falls are an important public health problem affecting about one third of adults 65 and older each year. Approximately 20-30% of those who fall will suffer moderate to severe

injuries, including hip fractures and head trauma. Fall-related injuries can reduce mobility and independence and often are serious enough to result in hospitalization and

increased risk of premature death. In 2001, over 1.6 million older adults were treated in

emergency rooms for fall-related injuries, and 373,000 were hospitalized. Adults aged 75 and older who fall are more likely to be admitted to a long-term care facility for a year or longer. In this same population over 60% of deaths are from falls.

V15.88 has been designated as a “First Listed or Additional” code. This code may be used to indicate a decision to order preventive evaluation or services or just to identify a patient at risk. Many patients who report they have fallen may not have suffered an injury but statistics show that those who have fallen in the past year, or have a history of falls are much more likely to fall resulting in serious injury. Once patients with a history of falls or other risk factors are identified, interventions are effective in lowering the incidence of falls causing serious injury.

The use of V15.88 could be advantageous in some instances. With a V code in M0230, M0245 is available to use any case mix diagnoses that may be related to an injury.

V49.6x and V49.7x Upper Limb Amputation Status and Lower Limb Amputation Status

The V40 series of codes are status codes. Status codes are usually for additional information only and are usually secondary only. The V code table moves these two subcategories to the “First or Additional” list.

Amputation status is likely important to any plan of care so can be coded any time a patient has had an amputation recently (providing aftercare) or if they have had an amputation in the past. In fact, the Coding Clinic names these codes as a co-morbidity that should always be coded, even in the absence of intervention. If the amputation is complicated because of a neuroma or an infection, then the status code should not be used. The complication code 997.6x should be used instead.

The Official Coding Guidelines affect all payors and providers. Even though this article referred to M0230 and M0240, the same concepts apply to those not completing OASIS. The new Official Coding Guidelines can be found at: http://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide05.pdf

The Commencement of a New Means to Distribute Information within the Home Care Industry

2006-08-29T02:34:00Z

Selman Holman and Associates is thrilled to proclaim the commencement of a new means to distribute information within the Home Care Industry.

Home Health Insight, a blogg produced and owned by Selman Holman and Associates, was created to be an information resource for Home Health Agencies across America.

On this site you will see frequently updated pieces from Selman Holman and Associates staff concerning pertinent and timely information that your home health agency needs to know.

This is a complimentary service provided by Selman Holman and Associates.

The Scoop on Dialysis--Coverage, Coding It, and Answering OASIS

2006-08-29T02:28:00Z

There are so many clinicians new to home health and there are so many things to know—PPS, OASIS, coding, coverage, just to name a few. There have been many misunderstandings about the role of dialysis in home health. What to do with your patient on dialysis? Do you document the dialysis catheter? Can you take care of it? How do I code it and do I need to code it? What about OASIS?

Coverage

Dialysis-related services are not a covered service under the home health benefit. The Code of Federal Regulations, Section 409.49 (e), dated December 20, 1994, specifically excludes services which must be provided by an End Stage Renal Disease (ESRD) facility. “Services that are covered under the ESRD program and are contained in the composite rate reimbursement methodology, including any service that is directly related to that individual’s dialysis, are excluded from coverage under the Medicare home health benefit.”

Dialysis related services are not covered under the home health benefit. Any and all dialysis-related services are the responsibility of an ESRD facility.

Dialysis-related services that are not covered:

· Treatment of an infected shunt site

· Epogen injections

· Venipuncture for dialysis-related labs

· CAPD/PD

· Hemodialysis

Renal-related services that may be covered include:

· Treating an abandoned shunt site

· Medical treatment not related to the dialysis, i.e., decubitus wound care

· Teaching the administration of non-dialysis related medications

Dialysis-related services that are not covered should not be included as part of your Plan of Care, i.e., they require no interventions. In the past, there were consultants that would inform agencies that the agency should not document that the patient was on dialysis or include the dialysis catheter in the assessment for fear that the home health services would be denied. This instruction is not correct. A complete assessment should include the presence of dialysis catheters. The initial assessment includes the baseline assessment of your patient and should reflect all of the findings. Omitting documentation reflecting the presence of the catheter makes the assessment incomplete. There is little danger in documenting the presence of the catheter or that your patient goes to a dialysis center three times a week, as long as your documentation also reflects the services that the home health agency is providing. There should be no doubt that you are not providing dialysis-related services that could be denied.

Coding It

There are two codes to consider in indicating dialysis services. The first is the V56 category (Encounter for dialysis and dialysis catheter care). This code indicates that the agency is providing the dialysis or the dialysis catheter care. The use of codes in this category indicates that the agency is providing services that are not covered by the home health benefit. The agency will be at risk for denial of services.

If, on the other hand, you are trying to indicate the patient is receiving dialysis, then the code is V45.1 (renal dialysis status), which indicates that there is an arterial venous shunt present or the patient is receiving hemodialysis, but the agency is not providing the services. The code, V45.1, is a better choice of codes for your patient who is on dialysis, however, because V45.1 is a status code, code it only if it is pertinent to your plan of care.

Answering OASIS

The dialysis catheter is treated just like an implanted venous access device or central line in answering the OASIS M0 data items. A dialysis catheter of any kind is considered a surgical wound for OASIS purposes. (See Q.106 in Category 4b of the OASIS Q and A). Even if no care is being provided regarding the dialysis catheter, the assessing clinician should answer ‘yes’ to M0440 ‘Does this patient have a skin lesion or an open wound?’ and answer ‘yes’ to M0482 ‘Does this patient have a surgical wound?’ Case mix points are available for the dialysis catheter on M0488 ‘Status of Most Problematic (Observable) Surgical Wound’ if early/partial granulation (7 points) or not healing (15 points) is checked. The Q and A states that the dialysis catheter can never be better than fully granulating because the device keeps the wound from healing completely.

To answer M0488, the wound must be visualized. If a dressing covers the peritoneal dialysis catheter or AV shunt, is it removable? If it is not removable, then the wound is nonobservable and no points are available. If the dressing is removable, the clinician should assess the wound for its size, status, drainage, edema, etc., answer M0488 and document the findings. No further care will be provided other than including it in your assessment of the skin on subsequent visits and OASIS assessments.