Home Health ICD-9/ICD-10 Alert

Published on Fri Jan 20, 2012 PDF

Welcome back points for new dementia codes.

The loss of case mix points for hypertension codes 401.1 (Benign essential hypertension) and 401.9 (Unspecified essential hypertension) weren't the only case mix changes the 2012 Home Health PPS final rule brought about. Take note of these additional updates to the diagnosis codes eligible for case mix points.

Dementia: At first the new 2012 dementia codes 294.20 (Dementia, unspecified, without behavioral disturbance) and 294.21 (Dementia, unspecified, with behavioral disturbance) seemed to have been left off the case mix diagnosis code list despite the fact that the 2011 code for dementia, NOS is 294.8 was a case mix code. Thankfully, efforts to correct this problem by Eli contributing editor Lisa Selman-Holman, JD, BSN, RN, HCS-D, HCS-O, COS-C, of Selman-Holman & Associates and CoDR -- Coding Done Right in Denton, Texas helped move the Centers for Medicare & Medicaid Services to update the Home Health PPS Grouper to include these codes in the case-mix system, and issued a correction for OASIS records with a date of Oct. 1, 2011 and later. The new dementia codes are included in the Psych 2 case-mix category.

Intrapelvic protrusion: CMS has removed 718.60 (Unpecified intrapelvic protrusion of acetabulum, site unspecified) from the case mix list, Selman-Holman says. But don't worry about this change. This code was added to the case mix list in error long ago and really shouldn't have been used.

Why: The only acceptable fifth digit for 718.60 is "5" indicating "pelvic region and thigh," so a fifth digit of "0" for site unspecified is unacceptable, Selman-Holman says. The acetabulum is the socket for the head of the femur forming the hip joint.