Eli's Hospice Insider

Published on Tue Aug 21, 2012 PDF

Pointer: You don't necessarily have to hire a credentialed coder.

Hospices that haven't been complying with regulatory requirements to list all related diagnoses on the claim need to get up to speed on the topic pronto -- preferably before the diagnoses start impacting payment. Follow this advice from coding expert Lisa Selman-Holman with Selman-Holman & Associates and CoDR -- Coding Done Right in Denton, Texas to bone up on your hospice coding requirements:

1. Designate your coder. Whether you use an already-qualified coder or find someone who is willing to learn the skill, you need to designate a person responsible for coding in your organization.

2. Seek out education. Your coder can start learning the basics by reading the ICD-9-CM Official Guidelines for Coding and Reporting, which are available from the Centers for Disease Control at www.cdc.gov/nchs/data/icd9/icd9cm_guidelines_2011.pdf. Then she should take some classes on the topic.

Don't expect much help from Medicare on this issue. In a question-and-answer posted by HHH Medicare Administrative Contractor CGS in May, a hospice asks for a list of hospice-appropriate diagnosis codes. "The patient's physician determines what diagnosis is most likely to cause the beneficiary's death within six months," CGS says in the Q&A at www.cgsmedicare.com/hhh/education/faqs/hospice_clinical_faqs.html. "CGS does not advise or guide providers on choosing diagnoses; these need to be determined by the physician."

3. Consider outsourcing. If you aren't confident in your coding skills, you may consider outsourcing coding to a vendor such as Selman-Holman's CoDR company. "Many companies ... will code for you," she advises.