OASIS Alert
Expert Sheds Some Light on Risk Adjustment Grey Area
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Must you sacrifice risk adjustment to CMS's letter of the law? At one time, there was an OASIS Q&A from the Centers for Medicare & Medicaid Services that permitted coders to list non-case mix diagnoses for risk adjustment in M1024 (Payment diagnoses). But that item, along with another that mentioned repeating case mix diagnoses in M1024, were removed in the September 2009 Q&A update, says Sparkle Sparks, MPT, HCS-D, COS-C, with Redmond, Wash.-based OASIS Answers. "There is more to coding than reimbursement," 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. "There is painting an accurate picture of the patient's health to reflect the plan of care, and there is risk adjustment. But coders shouldn't worry about risk adjustment for non-case mix codes not placed in M1024." Tip: M1024 is not the only data item that will provide risk adjustment for those conditions that may no longer exist (resolved conditions) and fractures, Selman-Holman says. These conditions would also possibly be placed in M1010 (Inpatient Diagnoses) and M1016 (Diagnoses Requiring Change in Treatment Regimen).
OASIS Alert
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