Home Health & Hospice Week

Get ready to defend your outpatient therapy claims.

You'd better make sure your therapy documentation is more airtight than ever. Regional home health intermediary Cahaba GBA has announced it will scrutinize V57.1 (Other physical therapy) in coming months.

However, the RHHI will limit this particular widespread review to outpatient home health patients only, it notes in a posting on its Web site. In other words, the review will apply only to Part B therapy patients. Cahaba will select home health outpatient claims with type of bill 34X, revenue code 042X and V57.1 as primary.

"The claims will be reviewed for medical necessity (e.g. compliance with [Centers for Medicare & Medicaid Services] guidelines, contractor Local Coverage Determinations (LCDs), correct billing and coding)," the intermediary explains.

Watch out: HHAs may run into high denial rates if they haven't adjusted for new coding rules that took effect in December, coding experts warn. They require using V57.1 as a primary diagnosis only (see Eli's HCW, Vol. XIV, No. 45).

Note: More details are at www.cahabagba.com/part_a/whats_new/20060505_probe.htm. For more information on home health diagnosis coding, see Eli's Home Health ICD-9 Alert at www.elihealthcare.com or by calling 1-800-874-9180.