170 codes no longer case-mix-What do we do?

Much of my day is spent perusing Medicare regulations and Q&As, OASIS regulations and Q&As, ICD coding regulations, home health listservs, home health blogs and other social media outlets pertaining to home health care.

Several months ago, there was some buzz about the Home Health PPS changes that would go in to effect on January 1, 2014 reducing the case mix diagnosis list by over 170 codes. Since January 1, 2014, I have heard and read some interesting and alarming comments:

“The 170 codes can no longer be entered on a home health Medicare claim-the claim will be rejected” “we can no longer use these codes, ever” “We need to find other codes to replace these codes” “These codes are no longer acceptable”.

While it is true that most of the 170 diagnoses are not appropriate for home health, there are a few that we see quite often in home care and agencies are struggling to determine how to handle the change. Since there is so much confusion, I thought I would clarify what these changes mean for home health care and coding.

The following statements are true about the 170 codes:

• The codes are still valid codes
• The codes no longer garner case mix points
• The codes should still be used, if they meet the OASIS and coding guidelines for selection

OASIS regulations and coding guidelines require that ICD codes are selected based on documentation of the patient’s condition and the home health plan of care. The primary diagnosis should be the diagnosis most related to the patient’s current plan of care. The secondary diagnoses are defined as “all conditions that coexisted at the time the plan of care was established, or which developed subsequently, or affect the treatment or care”.

It is never appropriate to consider case mix weight status when assigning the appropriate ICD code. If a code is appropriate based on OASIS and coding guidelines, it should be assigned.

If you have any questions or would like more information regarding QIRT, please contact us.

Until next time,

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