Home Health & Hospice

Homecare Aptitude Test: Pertinent Diagnoses

Homecare Insider, March 30, 2009

Your patient is receiving skilled nursing after hospitalization for congestive heart failure.  Which of the following conditions should you report as a pertinent diagnosis?

a. Hemiplegia (438.22) from a stroke three years ago
b. Hypertension (401.9), last medication change five years ago
c. Prostate cancer (185) six years ago with no recurrence
d. Bronchopneumonia (485) treated in the hospital one week before discharge
e. Lives alone (V60.3)

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Here are the answers for the homecare aptitude test.

Report the following diagnoses on the plan of care.
a. Hemiplegia.  This is a residual effect of the stroke that has an impact on the patient’s rehabilitative prognosis and response to treatment, and it helps justify homebound status.
b. Hypertension.  Even though there have been no medication changes for five years, this is still a relevant comorbidity, which makes it a pertinent diagnosis.  It has an impact on the patient’s response to treatment and rehabilitative prognosis.
d. Bronchopneumonia.  Even if this condition was treated in the hospital, there still may be reason for concern.  Observation and assessment provides a three-week window to verify that the patient’s condition is truly stable.

Do not report these diagnoses.
c. Prostate cancer.  After six years with no symptoms, the condition is historical.  Some might consider reporting it as a personal history (V10.46).  This V code explains a past medical condition that no longer exists and is not receiving any treatment.  It is not a relevant diagnosis for the homecare plan, as it does not support any skilled interventions.  Even though there is the potential for recurrence, which may imply the need for monitoring, this would not meet Medicare coverage criteria for reasonable and necessary care.
e. Lives alone.  This miscellaneous V code provides information about circumstances that may affect the patient’s care and treatment.  It is important for staff to know and address this circumstance.  However, as with history V codes, this code does nothing to support medically necessary homecare services.
Pertinent diagnoses play a very important role in outcomes and payment.  Unfortunately, Attachment D to the OASIS User’s Manual has created confusion and controversy.  Dial in for Beacon Health’s audio conference on April 16 and get the straight facts about diagnoses and diagnosis coding.  Click here for information.