Rehab code acceptable only as primary diagnosis, new guidelines say.
If you're still reporting V57.x as a secondary diagnosis, you could be jeopardizing your therapy claims.
As of Dec. 1, coding guidelines advise that V57.x (Care involving use of rehabilitation procedures) has been added to the list of V codes which are only acceptable as principal or first-listed diagnoses.
"This means that if therapy is the primary reason for home health, then V57.x would be coded first. Otherwise, you wouldn't code it," says consultant Lisa Selman-Holman with Selman-Holman & Associates in Denton, TX. If you are providing more than one therapy, you may report V57.89 (Multiple training or therapy) in M0230, she advises.
The new coding guidelines are at
www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide05.pdf.
For more information, see Eli's Home Health ICD-9 Alert, available at
www.elihealthcare.com or by calling 1-800-874-9180. • If the Comprehensive Error Rate Testing auditor didn't do a good job of following up with you about its documentation requests, then you're not alone.
CERT contractor AdvanceMed didn't always follow up via phone if you failed to send in medical records after the first request, complains the HHS Office of Inspector General in a recent report on the CERT program. But AdvanceMed did a better job of completing quality assurance reviews properly than it did the last time the OIG scrutinized its practices.
The Centers for Medicare & Medicaid Services could be doing better at making sure that the CERT program is consistent, the OIG adds in its report (A-03-05-00006). The OIG recommended that CMS centralize the management of the CERT program and make sure the sampling periods for CERT audits are the same every time. • One more home health agency has seen its favorable Provider Reimbursement Review Board decision on therapist compensation reversed by the CMS Administrator.
CMS has overturned Colorado Home Care Inc.'s September PRRB decision, where the Board disallowed application of salary equivalency guidelines for outside therapists to directly employed therapists' compensation (see Eli's HCW, Vol. XIV, No. 35).
"Contrary to the Board's finding that the employment relationship between the Provider and the physical therapists determined whether the Guidelines should be applied, the Administrator finds that the fee-for-service compensation of the Provider's therapists was the controlling factor in the application of the limits in this case," the Administrator says in the decision.
When the PRRB issued its decision, Colorado Home Care's attorney said the agency planned to appeal an anticipated CMS reversal. • The Texas HHA owner and doctor's office manager accused of administering fake flu shots may soon face the music for the alleged misdeeds. Iyad Abu El Hawa, owner of Comfort & Caring Home Health in Houston, and Martha Denise Gonzales were indicted last month on charges that they conspired to inoculate [...]
