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Home Health & Hospice Week

Diagnosis Coding:

Diagnosis Codes Slated For Elimination No Longer Predict Costs, CMS Says

Published on Wed Jun 15, 2011

Use of 401.9 more than doubled in last five years. The Centers for Medicare & Medicaid Services points to statistics to justify scrapping two hypertension codes from the home health prospective payment system case mix model in 2012. From 2005 to 2009, use of 401.9 (Essential hypertension, unspecified) increased from 27 percent of episodes to 56 percent, CMS notes in the 2012 PPS proposed rule published in the July 12 Federal Register. In the same time period, the other code proposed for reduction, 401.1 (Benign essential hypertension), increased only from 2.89 to 2.95 percent of episodes. Probably due to the widespread use of these codes, "current data indicates that these diagnoses are not predictors of higher home health patient resource costs," CMS says in the rule. "Rather, current data indicates a lower cost associated with home health patients when these codes are reported." Other hypertension codes saw big jumps as [...]
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