OASIS Alert

In a few short months new ICD-9-CM codes will go into effect, and if you drop the ball on updating the codes you use, your reimbursement could drop like a lead balloon.

"Medicare systems are required to install andacceptnewandrevised2002ICD-9-CM[codes] for claims processed on or after October 1, 2002," the Centers for Medicare & Medicaid Services spells out in June 21 program memorandum AB-02-085. "ICD-9 codes are updated annually."

Medicare contractors "should emphasize the importance for providers to use the most recent version of ICD-9-CM coding book and to code to the highest level of specificity," CMS adds.

CMS has posted the new codes effective Oct.1at www.cms.hhs.gov/medlearn/icd9code.asp.

Home health agencies that fail to update their coding practices will waste time and money, warns consultant Pat Sevast with American Express Tax & Business Services in Timonium, MD. Claims will come back rejected for invalid codes, delaying the HHAs' cash flow. Or agencies will fail to code patients' diagnoses to a new, higher specificity, incurring medical reviewers' wrath.

To avoid those problems, agencies should review the new codes, advises coding expert Prinny Rose Abraham with HIQM Consulting in Minneapolis. HHAs can determine which codes they most frequently use and analyze them for impact on documentation and reimbursement requirements.

Topping the list of home health-utilized codes that will become invalid is 998.3 (disruption of operation wound), Sevast points out. Two more specific codes 998.31 (disruption of internal operation wound) and 998.32 (disruption of external operation wound) will replace it.

Two more soon-to-be invalid codes agencies use are 357.8 (other inflammatory and toxic neuropathy) and 359.8 (other myopathies), she adds. The neuropathy code will be replaced with 357.81 (chronic inflammatory demyelinating polyneuritis), 357.82 (critical illness polyneuropathy) and 357.89 (other inflammatory and toxic neuropathy). The myopathy code will become 359.81 (critical illness myopathy) and 359.89 (other myopathies).

A more subtle danger may be with codes that don't become invalid, but more specific versions of the code are available, experts warn. For example, come October, 428.0 (congestive heart failure) will be split into 12 more specific codes from 428.20 to 428.43 indicating the specific heart problem. But 428.0 still will be available for use as well.

"If agencies have more information from the doctor, they can code that more specifically," says Sevast. "But agencies usually won't get that specific information," in which case using the general 428.0 is fine.

But that should be a conscious choice, not a choice made of ignorance, experts warn.

HHAs should use the new diagnosis codes based on date of service, not on the date of the claim, Sevast reminds providers. Agencies will have a bit of time to get used to the new codes. Medicare allows a grace period from Oct. 1 to Dec. 31 where "Medicare systems must accept both the old and new ICD-9-CM codes," the memo says.

To ensure coding update success, home health agencies should: