Home Health & Hospice

Q: Can you provide any tips for what my agency needs to be aware of when reviewing the ICD-10 draft case-mix codes?

Homecare Insider, December 2, 2013

Q: There is a lot to keep track of with the ICD-10 code changes in the 2014 final rule for home health. Can you provide any tips for what my agency needs to be aware of when reviewing the ICD-10 draft case-mix codes?

A: According to Joan Usher, BS, RHIA, COS-C, ACE, president of JLU Health Record Systems in Pembroke, Mass., HHAs should consider the following when reviewing the ICD-10 draft case mix codes:

  • The eliminated case mix codes (170 total codes) from the January 1, 2014 rule are still present in the listing.
  • CMS stated that when using the General Equivalence Mappings (GEMs) translation for injuries, the default code for the 7th character is “A,” initial encounter. This is not the correct 7th character for home health, which is the subsequent encounter.
  • CMS eliminated the codes for non-specific conditions when the clinician should be able to identify a more specific diagnosis based on clinical assessment such as laterality (e.g., left, right, bilateral).