Home Health ICD-9/ICD-10 Alert

Published on Thu Jul 01, 2004 PDF

Take this case-mix refresher course to make sure your practice is on track

CMS says in its OASIS instructions that M0245 is an optional item -- but that's only true if your home health agency sees obtaining correct reimbursement as optional.

Many HHAs are still in the dark about M0245, says Joie Glenn with the New Mexico Association for Home Care. Unless you train your coders appropriately on M0245 and case-mix diagnoses, you could face major reimbursement pitfalls, Glenn warns.

Prinny Rose Abraham, RHIT, CPHQ, a home health coding expert with Minneapolis-based HIQM Consulting, explains how to protect your agency's reimbursement by treating M0245 as another skip pattern in the OASIS document.

If a V code is present in M0230 (primary diagnosis), HHAs should determine if the diagnosis it replaces is a "case-mix diagnosis" -- one that makes a difference to payment under the current, pre-October 2003 coding rules, Abraham says. If so, agencies should place the case-mix diagnosis in M0245 to receive payment for that diagnosis.

Case-mix diagnoses -- the neurological, orthopedic, diabetic and trauma codes listed in Table 8 of the prospective payment system regulation -- add from 11 to 21 points to the clinical dimension of the patient's case-mix category.

To assist with the skip pattern, HHAs can mark those diagnoses in their coding books or information systems or purchase coding books where they are already marked, Abraham says.

You should already be using this automatic pattern to make sure you're receiving your rightful reimbursement:

Occasionally, to receive the increased payment, agencies will have to place both a primary diagnosis and a manifestation code (that is, the case-mix diagnosis and secondary diagnosis) in lines A and B of M0245, just as they are now in lines A and B of M0230, Abraham adds.