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The impact of that could be a reduction of hundreds of dollars per episode. A 77-year-old man comes to home health with a diagnosis of alcoholic cirrhosis with ascites. He has a diagnosis of alcoholism but the medical record says it is in remission and he is not continuing to drink. Just as before, only one clinician may take responsibility for accurately completing a comprehensive assessment. In such a scenario you’ll assign D63.1 immediately after a code from N18.- (Chronic kidney disease ) for the CKD stage, according to tabular instruction.
By joining Syneos Health, you’ll be connected to our multitude of career paths and pipeline of employment opportunities. DecisionHealth’s Coding Manual includes a wide range of features to help ensure accurate coding and compliance, prevent denials and help your agency secure every reimbursement dollar earned. Plus, the 2023 edition includes features that will support your ongoing PDGM training needs. Audits for adherence to plans of care and identifies document deficient trends with comprehensive chart audits.
Supervisory visits ensure home health agencies maintain high quality and standards
Train clinicians how to ask whether patients have lost interest in activities or if they have been feeling sad. These questions will lead to more accurate assessments and better depression treatment that can lower your rehospitalization rates and improve your star ratings. "To free up time for clinical supervisors, we shifted roles, allowing those supervisors to spend less time dealing with task-related issues and have quality partners to give them cues on employee work," Koss says. "Additionally, we added an LPN to the office to triage all patient and clinician calls so that the clinical supervisors only receive the calls that need to be escalated to their levels."
Z47.89 and Z48.89 specifically have been used as catch-all codes and, while they sometimes are used appropriately, they often aren’t, says Trish Twombly, HCS-D, senior director for DecisionHealth in Gaithersburg, Md. This is a costly mistake that results in a loss of clinical points and potentially $500 or so on episodes, she says. This clarification supports the knowledge never to mark an ulcer with slough or eschar of any type as Stage 2 on the OASIS but rather at least a Stage 3 if those are present in the wound bed. With the Home Health Coding Center, DecisionHealth provides all the official guidance with plain-English interpretation from nationally recognized home health coding experts – updated in real-time! There's no better way to ensure full reimbursement and increased accuracy! Whether this new Coding Clinic guidance will lead to higher, lower, or unchanged levels of reimbursement is a question that will answered over time.
Keep your sanity when coding mental conditions
The external cause code, X15.0xxD is assigned to capture how the patient sustained the burn, in accordance with tabular instruction. The patient’s long-term use of antibiotics comes with certain risks and thus is coded with Z79.2. Because GG0130 and GG0170 involve so many different components and have been such a challenge for clinicians, the various guidance around these items is among the most noteworthy in the January 2019 Q&A update, experts say. The statement raised questions for many industry experts because it didn’t align with guidance around physician-ordered start of care dates, which must be a specific date and not a date range. The statement also appeared to conflict with other guidance within the manual. The J11 code category also applies when documentation from the physician indicates “flu” or “influenza” as a confirmed diagnosis but gives no further detail.
Though the patient’s arthritis was documented by the physical therapist as affecting his knees, this was not corroborated in the physician’s documentation and a call seeking confirmation was not returned. Therefore, it must be coded with M19.90, according to coding guidelines and Coding Clinic guidance. A 73-year-old man recently underwent coronary artery bypass surgery to treat severe coronary artery disease. His comorbidities include diabetes, for which he takes oral hypoglycemic medication, and arthritis, for which his physician ordered physical therapy. The physical therapist’s assessment indicated that the arthritis affects his knees. However, the physician’s documentation doesn’t include this detail and the call to the physician’s office seeking confirmation was not returned.
Featured Benchmark: How much agencies will spend on CoPs training
With the ability to drill into clinician-specific data, agencies can identify common diagnosis, OASIS, and star rating pitfalls to inform focused improvement plans. As part of our commitment to be your total home care agency resource, our clinical and regulatory departments also ensure that regulatory coding standards are met. The educational component to our services empowers agencies to truly thrive. Our experienced clinical team offers structured educational programs to increase agency competency on QI, QAPI, regulations, laws, general coding, assist in accreditation, and more. Our coding department is comprised of experienced, industry-leading specialists—certified RNs—who are available to elevate your agency’s coding process.
And like certain other neoplasms, such as melanoma and leukemia, codes for malignant carcinoid tumors are not found in the Neoplasm Table. That’s because malignant carcinoid tumors are a specific type of cancer known as neuroendocrine tumors. These tumors grow in cells that make hormones and can occur in various areas of body including the organs of the digestive system, lungs, pancreas, ovaries and thyroid, according to WebMD. In July 2018, CMS released an errata detailing 17 areas with identified errors to the draft guidance manual. A 75-year-old patient is admitted to home health after a hospital stay for Influenza B with pneumonia. Those changes were all outlined in the original 17-item July errata but did not appear in the final manual.
Don’t lose sight of the rules when coding blindness & low vision
Use CMS' newly posted provider training materials to ensure clinicians fully understand what to mark on the OASIS when the patient can’t move from a lying position to sitting on the side of the bed. In contrast with what the home health industry thinks of as QA procedures, CDI is done concurrently with the admission for conflicting, incomplete or nonspecific documentation as opposed to an after-the-fact review, she says. It’s an audit of the documentation in the record before it gets to the coder’s desk.
Since the skin donor site is also receiving care, Z48.298 is assigned, and the wound is captured on the OASIS as a surgical wound. A reepithelialized pressure ulcer will only ever regain up to 80% of its tensile strength and therefore is never truly healed, according to Dea Kent, RN, NP-C, CWOCN director nursing home oversight & consulting, in Fishers, Ind. It isn’t clinical practice to reverse stage pressure ulcers because they don’t heal in reverse order and will never be completely restored, she says. Clinicians should not re-stage a reopened pressure ulcer as they would a new wound on OASIS-C2, something that is particularly important to remember at start of care. If the muscle flap heals (edges are completely re-epithelialized and the incision is clean, dry and closed with no signs or symptoms of infection for at least 30 days) this becomes a scar and is no longer reported as a surgical wound.
The patient has confirmed diagnosis of diabetes mellitus with hyperglycemia. Consider a patient referred to home health for treatment for dysphagia and dysarthria whose medical record documentation doesn’t state whether a stroke caused those two symptoms. If you’re unable to reach the physician to ask for a more definitive diagnosis, the guidelines state you must assign the symptom codes R13.10 and R47.1 . The neoplasms causing the neoplasm-related pain are coded as additional diagnoses, in accordance with coding guidelines. As the focus of care, the pain related to the cancer is coded in the primary position, in accordance with coding guidelines.
In the Q&As, CMS also provides guidance on items capturing information on height and weight, wounds, medication management and active diagnoses. Industry experts say GG0130 (Self-care) and GG0170 are among the biggest hurdles for clinicians during the transition to OASIS-D. So it’s no wonder that 26 of the 32 new Q&As deal with the six items new to the OASIS, including GG0130 and GG0170. If agencies conduct a ROC visit outside the 48-hour window and after the physician-ordered ROC date, they would be out of compliance with timely initiation of care.
Good clinical documentation improves the quality of care, supports better communication, and reduces claim denials. Enhance your current CDI program with flexible and built-to-suit CDI services guided by highly skilled and passionate medical professionals. Formatting changes were made — where responses are mutually exclusive — throughout the item set to convert multiple checkboxes to a single box for data entry and to change the numbering for pressure ulcer staging from Roman to Arabic numerals.
Per guidance at E89.1, E13.51 captures the diagnosis of other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene. Because the lack of a pancreas caused the lack of insulin, code the absence of the pancreas. Diabetic PVD and glaucoma are relevant comorbidities that could impact the patient’s recovery and are thus coded as additional diagnoses. However, the subterms indented under “with” direct coders to more specific J codes within the same section — Chronic lower respiratory diseases (J40-J47). An example of this is J44.1 (Chronic obstructive pulmonary disease with exacerbation). This is because mental conditions are important comorbidities that will impact a patient’s care and thus should be reported, says Trish Twombly, HCS-D, an independent home health consultant and coding expert based in Dallas.
An additional code (Z91.83) assigned to capture the patient’s wandering, in accordance with tabular instruction. But only four changes outlined in the errata are reflected in the final guidance manual released Dec. 20, 2018. They include updating language around pressure ulcers and pressure injuries and correcting the spelling of the word “transfer” in GG0170F, which addresses toilet transfer.
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