Home Health & Hospice Articles by Topic: ICD-10

Educate physicians on PDGM requirements to obtain documentation more quickly

• Homecare Direction, Issue 2, February 14, 2020

  Agencies should make a partnership with physicians to educate them about the Patient-Driven...

Choosing the correct primary diabetes code is key to payment, compliance

• Homecare Direction, Issue 2, February 14, 2020

  Coding for diabetes and associated conditions can be tricky — and with PDGM in effect, the...

Most common home health primary diagnosis codes by PDGM clinical group

• Homecare Direction, Issue 2, February 14, 2020

  A diabetes code was the most commonly coded primary diagnosis in both the wound and endocrine...

What is the appropriate primary diagnosis code for a patient who has had spinal fusion surgery?

• Homecare Q&A, Issue 1, January 27, 2020

  M43.26 refers to a natural/pathological fusion of the spine, not a surgical fusion.

A patient has aggressive fungating breast cancer wound and had a biopsy in August 2019. How should this wound be coded?

• Homecare Q&A, Issue 1, January 27, 2020

  If wound care is your primary focus of care, you can select Z48.00 (Encounter for change or...

Top 10 invalid primary diagnosis codes in PDGM

• Homecare Direction, Issue 1, January 14, 2020

  Muscle weakness (generalized) was the most commonly used primary diagnosis that would be...

Update your process to handle muscle weakness diagnoses under PDGM

• Homecare Direction, Issue 1, January 14, 2020

  Muscle weakness is one of the most commonly seen and assigned primary diagnosis codes in home...

Some code changes were finalized, dysphagia joins acceptable primary list

• Homecare Direction, Issue 12, December 6, 2019

  Coders will now be able to assign six R-codes for  dysphagia as a primary diagnosis under the...

If the primary diagnosis doesn't make sense for the second 30-day payment period under PDGM, how should we go about updating the primary diagnosis?

• Homecare Q&A, Issue 11, November 25, 2019

  There are two ways to update a primary diagnosis. Medicare has said that agencies can update the...

Is it likely CMS will make any adjustments to the list of acceptable primary diagnosis codes outside rulemaking?

• Homecare Q&A, Issue 11, November 25, 2019

  I don’t think so because they seem to be somewhat grudging to do it within the rulemaking...

Implement a process for patient condition changes between PDGM periods

• Homecare Direction, Issue 11, November 8, 2019

  Agencies should consider establishing processes for how to handle changes in a patient’s...

Keep your sanity when coding mental conditions

• Homecare Direction, Issue 10, October 11, 2019

  Code a psychiatric condition if a patient’s been diagnosed with one, whether or not...

Since R26.89 is not a valid primary diagnosis under PDGM, how should agencies code abnormality of gait due to TBI after PDGM takes effect?

• Homecare Q&A, Issue 9, September 23, 2019

  Unfotunately we do not have answers to this yet. There are instances where coding guidance tells us...

Pressure-induced deep tissue injuries noted in updated FY2020 coding guidelines

• Homecare Direction, Issue 9, September 4, 2019

  Several key changes were made to coding guidance as part of the FY2020 ICD-10-CM Guidelines for...

Will a follow-up OASIS with a different diagnosis than the start of care (SOC) OASIS affect billing at the end of the episode?

• Homecare Q&A, Issue 8, August 26, 2019

  Yes. It’s kind of complex the way billing is going to work. If the clinician conducts a SOC...

If a patient has a significant change in the middle of the first 30-days period, does a new plan of care have to be submitted, and what are recommendations for coding with that?

• Homecare Q&A, Issue 8, August 26, 2019

  It depends on the agency’s policy but if the patient’s change is really significant...

Can you code infection as an underlying cause for weakness when the patient is not currently on antibiotics?

• Homecare Q&A, Issue 8, August 26, 2019

   It will depend a lot on documentation. This may be something to query. For example, even if...

What areas are crucial for coders to be diving into right now in order to prepare for PDGM?

• Homecare Q&A, Issue 8, August 26, 2019

  It’s going to be important that coders get familiar with what a valid diagnosis is in PDGM...

Removal of some PDGM primary codes, comorbidity groups proposed

• Homecare Direction, Issue 8, August 7, 2019

  It’s more important than ever for agencies to take steps to ensure they are prepared for the...

There has been some confusion around how to code various types of atrial fibrillation. Will new FY2020 codes help clear up some of that confusion?

• Homecare Q&A, Issue 7, July 29, 2019

  Honestly, because we don’t get a lot of documentation for atrial fibrillation, it may...

Should we code all diagnoses or only those affecting the plan of care?

• Homecare Q&A, Issue 7, July 29, 2019

  Unfortunately this is an instance of where we have conflicting regulations.

Final FY 2020 ICD-10-CM changes include hundreds of new tabular instructions

• Homecare Direction, Issue 7, July 8, 2019

  Starting Oct. 1, 2019, coders will have 25 new codes to specifically capture deep tissue injuries...

20 most common primary diagnoses in home health

• Homecare Direction, Issue 7, July 8, 2019

  Z47.1 (Aftercare following joint replacement surgery) and I10 (Essential (primary) hypertension...

More agencies will turn to outsourced coding as a result of PDGM

• Homecare Direction, Issue 7, July 8, 2019

  Industry experts believe the use of outsourced coding will grow as a result of how the...

How can intake help us avoid unspecified abnormalities of gait as a primary diagnosis?

• Homecare Q&A, Issue 6, June 28, 2019

  Intake could say to the referral source, “Does the patient have any neuropathy? Does the...

What should intake do with a primary diagnosis of M62.81?

• Homecare Q&A, Issue 6, June 28, 2019

  Since we know that’s going to be not acceptable as a primary diagnosis under PDGM, that is a...

Assign diabetes mellitus combination codes, avoid coding errors

• Homecare Direction, Issue 6, June 6, 2019

  When coding for diabetes with an associated manifestation, check for an existing combination code...

FY2020 proposed code changes: Pressure-induced deep tissue injuries

• Homecare Direction, Issue 5, May 8, 2019

  Coders may soon have a way to specifically capture deep tissue injuries. Twenty-five codes...

Charts coded in an average day

• Homecare Direction, Issue 4, April 8, 2019

  About 40% of coders code six to 10 charts in an average day, while about 30% of coders code about...

Coders: Documentation issues cause a major productivity slowdown

• Homecare Direction, Issue 4, April 8, 2019

  Incomplete information in medical records and having to call clinicians and/or physicians for...

Get coding right for obesity and BMI, stay in compliance

• Homecare Direction, Issue 2, February 5, 2019

  Code the fact that a patient was diagnosed as morbidly obese with E66.01 (Morbid (severe) obesity...

Pulmonary v. essential: All hypertension is not created equal

• Homecare Direction, Issue 1, January 4, 2019

  Be sure to both assign I10 (Essential (primary) hypertension) and I27.20 (Pulmonary hypertension...

Coding guidance update: Learn the new rules for coding body mass index

• Homecare Direction, Issue 12, December 5, 2018

  Assign a code for a patient’s body mass index (BMI) only when there is also a documented...

Avoid the ache of lost case-mix points when coding septic arthritis

• Homecare Direction, Issue 10, October 4, 2018

  Confirm the bug responsible for a patient’s septic arthritis infection and the specific...

What should I do if I take on a patient with a diagnosis that fits within one of the six clinical groups under PDGM?

• Homecare Q&A, Issue 14, September 21, 2018

  The 2019 proposed PPS rule references this concern in several areas.

FY2019 coding guidelines: Changes align with recent Coding Clinic guidance

• Homecare Direction, Issue 9, September 1, 2018

  Starting Oct. 1, coding guidelines will no longer allow for a connection to be assumed between...

Increase coding specificity to protect payment, ensure valid episodes under PDGM

• Homecare Direction, Issue 9, September 1, 2018

  Analyze your agency’s most commonly used primary diagnosis codes as a first step toward...

Remember to assign 'Y' codes to justify care, protect reimbursement

• Homecare Direction, Issue 8, August 1, 2018

  Use Y84.2 (Radiological procedure and radiotherapy as the cause of abnormal reaction of the...

How would you code a hematoma in the following situation?

• Homecare Q&A, Issue 11, July 15, 2018

  Your agency should call the physician and see if this has now elevated to an open wound.  

How do you code a wound in a specific situation involving venous insufficiency?

• Homecare Q&A, Issue 11, July 15, 2018

  In the specific scenario you describe, it would continue to be coded as a trauma wound that is...

Final list of 2019 ICD-10-CM codes includes 38 changes not in proposed list

• Homecare Direction, Issue 7, June 29, 2018

  A total of 473 code changes will take effect on Oct. 1, including 279 new codes, 143 revised codes...

How to code conditions resolved by surgery: No one-size-fits-all solution

• Homecare Direction, Issue 6, June 4, 2018

  Look to see whether the condition for which a patient had surgery is still being treated as a clue...

Surgical wound infection codes set to expand dramatically in FY2019

• Homecare Direction, Issue 5, May 2, 2018

  Home health coders could have 435 ICD-10-CM code changes to deal with starting Oct. 1, with 247 new...

Coding corner: Data reflects coding trends that could spell trouble down the road

• Homecare Direction, Issue 4, April 12, 2018

  If you’re frequently assigning I11.0 (Hypertensive heart disease with heart failure) in...

Would you use an aftercare code for debridement of a pressure ulcer or just the pressure ulcer code?

• Homecare Q&A, Issue 7, April 3, 2018

  Debriding a pressure ulcer does not change the nature of the wound or make it a surgical wound.

How do I code a post-operative hematoma following a left hip joint replacement?

• Homecare Q&A, Issue 7, April 3, 2018

  Code this as a complication of the joint replacement surgery with M96.840 (Postprocedural hematoma...

Coding corner: Correctly code congenital conditions, avoid coding errors

• Homecare Direction, Issue 3, March 29, 2018

  It’s not necessary to assign additional codes for symptoms or manifestations that are part of...

How do I sequence this code if it is a sequela of a TBI?

• Homecare Q&A, Issue 6, March 17, 2018

  Code the TBI first, with S06.9x0S (Unspecified intracranial injury without loss of consciousness...

Coding corner: Let the 7th character speak for injuries, avoid lost reimbursement

• Homecare Direction, Issue 2, February 23, 2018

  Code the patient’s injury — such as a frac-ture, a laceration or a burn — and...

Would it be correct to assign G91.9 (Hydrocephalus, unspecified) for a patient who's receiving home health services related to a diagnosis of congenital hydrocephalus?

• Homecare Q&A, Issue 4, February 19, 2018

  It would be incorrect to assign G91.9 (Hydrocephalus, unspecified) for a patient who’s...

I have a coding question on a patient with a little right toe that's become necrotic....

• Homecare Q&A, Issue 3, February 2, 2018

  You cannot code I96 (gangrene, not elsewhere classified) with a code from the I73.- category...

Coding corner: Use caution when following 'in' convention or risk coding errors, lost reimbursement

• Homecare Direction, Issue 1, January 26, 2018

  Ensure that medical record documenta-tion clearly documents a cancer patient’s anemia as...

What are the 2018 ICD-10 changes?

• Homecare Q&A, Issue 2, January 17, 2018

  There are approximately 363 new codes, 142 deletions, and more than 250 code revisions in the 2018...

Implement a back-up plan for coders' time off or prepare for cash flow losses

• Homecare E-News, Issue 3, January 15, 2018

  Not having a back-up coder on staff or an on-call contract with an outsourcing company to fill in...

Does code Z51.5 (encounter for palliative care) have to be the second diagnosis on a hospice patient?s NOE, or can it be coded further down? (This is for when there is MD supporting documentation for this code.) Thank you for your help and time.

• Homecare Q&A, Issue 1, January 3, 2018

  Thank you for your question and com-mitment to quality and compliance. Z51.5 does not have to be...

Coding Corner: Relieve the pressure of coding surgically treated pressure ulcers

• Homecare Direction, Issue 12, December 29, 2017

  Continue to code a pressure ulcer treated with a skin graft as a pressure ulcer that’s...

Coding corner: Commonly used codes will raise red flags in new proposed payment system

• Homecare Direction, Issue 11, November 2, 2017

  If you’re commonly assigning codes N39.0 (urinary tract infection, site not specified...

Coding corner: Avoid chest pain when new heart attack codes take effect

• Homecare Direction, Issue 10, October 27, 2017

  Ensure that you make the switch from I21.3 (Myocardial infarction (acute) NOS) to I21.9 (Acute...

Coding corner: FY 2018 coding guide-lines: "In" will be equivalent to "with" starting October 1

• Homecare Direction, Issue 9, September 18, 2017

  Conditions linked in the Alphabetic Index by the word “in” should be considered...

Coding corner: It takes two (codes) to get arterial ulcers right

• Homecare Direction, Issue 8, August 21, 2017

  Coding an arterial ulcer requires a minimum of two codes: one for the specific condition that...

Prepare for dozens of new and deleted codes not previewed in the proposed set

• Homecare Direction, Issue 7, July 17, 2017

  Starting October 1, 2017, you’ll be able to capture the severity of non-pressure chronic...

In Focus: CMS expands list of manifestation codes under ICD-10 effective October 2016

• Homecare E-News, Issue 32, August 22, 2016

  This week, the Centers for Medicare & Medicaid Services (CMS) issues Transmittal 3591. It...

Inside story | Coding diabetes and related conditions

• Homecare E-News, Issue 26, July 11, 2016

   The American Hospital Association (AHA) Coding Clinic has clarified the proper way to code...

Weekly Roundup

• Homecare E-News, Issue 25, June 27, 2016

  In this week's roundup: CMS revises ICD-10 codes. CMS officially finalized the first major...

Inside story | Proper coding for depression

• Homecare E-News, Issue 13, March 28, 2016

  ICD-10-CM classifies depression under Disorder, depressive, major (MDD), but more information is...

How would we code a trip and fall over a cat in ICD-10?

• Homecare Q&A, Issue 20, October 16, 2015

  How would we code a trip and fall over a cat in ICD-10?  

The Weekly Roundup

• Homecare E-News, Issue 39, October 5, 2015

  This past Thursday (October 1, 2015), began the live implementation of ICD-10 across the...

How will OASIS-C1/ICD-10 differ from the data set iteration currently in use?

• Homecare Q&A, Issue 0, June 9, 2015

   To accommodate the extended effectiveness of ICD-9 after the Protecting Access to Medicare...

Will home health remain exempt from overtime compensation in most circumstances like it has for 40 years?

• Homecare Insider, Issue 1, January 5, 2015

  Will home health remain exempt from overtime compensation in most circumstances like it has for 40...