Home Health ICD-9/ICD-10 Alert

Published on Thu Oct 20, 2011 PDF

Each year the ICD-9-CM Coordination and Maintenance Committee along with the Cooperating Parties update the diagnosis code set you'll use for the following fiscal year. Do you know when to start using the new codes and when you'll continue to report 2011 codes?

You'll base your decision for using the 2012 ICD-9 codes on M0090 -- Date Assessment Completed, says Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates and CoDR -- Coding Done Right in Denton, Texas.

The codes on the RAP (Request for anticipated payment) that you send to the intermediary after the plan of care has been sent to the physician and the OASIS has been locked must match the codes on the EOE (End of episode claim), Selman-Holman says.

So, if the M0090 date is before Oct. 1, 2011, you should report 2011 ICD-9 codes on both the RAP and the EOE.

But if the M0090 date falls on or after Oct. 1, 2011, you should report the new 2012 ICD-9 codes on both the RAP and the EOE.

Tip: Base your code selection on the M0090 date, not on the episode date, Selman-Holman says.

To get ready for Oct. 1, Selman-Holman suggests doing the following:

• Order a new 2012 ICD-9 coding manual. (Bonus: You'll be able to use this manual all the way up until ICD-10 October 1, 2013, she says.)
• Update any coding cheat sheets that you use. Or better yet, stop using cheat sheets and refer to your updated 2012 coding manual.
• Create lists of patients that will require code changes and when.

Example: Your patient Fred Davis has Alzheimer's disease and requires supervision for wandering off. When he recertifies on Oct. 12 you'll need to report new code V40.31 (Wandering in disease classified elsewhere) along with existing codes 331.0 (Alzheimer's disease) and 294.11 (Dementia in conditions classified elsewhere with behavioral disturbance).

The entry on your tracking sheet for this patient would look like this:

Davis, Fred Recert, Oct. 12, Wandering: V40.31