Home Health ICD-9/ICD-10 Alert

Published on Thu Apr 17, 2014 PDF

As a hospice provider, you must code thoroughly and accurately for your patients. To help you decide which diagnoses to include, Judy Adams, RN, BSN, HCS-D, HCS-O, with Adams Home Care Consulting in Asheville, N.C. suggested you ask the following questions:

• Why was the patient referred for hospice?
• Are there any comorbidities that may contribute to the terminal condition?
• Is there more than one problem that is actually causing or contributing to the terminal condition?
• Are there coding conventions that require additional codes or listing diagnoses in a specific order?

“Often, the most challenging question of all is ‘What makes the patient qualify for hospice now?’” Adams said during the recent Eli-sponsored audioconference Hospice Coding Update 2014. “What’s changed? What’s happening? That’s part of our decision making when we admit a patient for hospice and we need to reflect that thinking to show CMS why we’re admitting the patient.”

Each agency must develop a process for determining which diagnoses they will add to the plan of care and claim as related to the terminal diagnoses, Adams said. You’ll also need to have a process in place for determining which diagnoses a patient may have that you will document in the clinical record as “other diagnoses.” These are diagnoses that you are aware of, but that aren’t related to the terminal diagnosis.

As you develop your process, you’ll need to decide who should participate in this decision making process, Adams said. You’ll also need to establish the criteria you’ll use to differentiate diagnoses that are related to the terminal diagnosis versus general unrelated co-morbid diagnoses.