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Consider Carefully Before Putting ICD-9 Code 344.61 In M0230

Published on Fri Feb 20, 2004

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If you don't have documentation to support case mix code 344.61, expect a denial, one RHHI says.

Cauda Equina Syndrome with Neurogenic Bladder (344.61) is one of the case mix codes that increases the home health resource group and in turn leads to extra episode reimbursement. But if you choose that code for the primary diagnosis in M0230, be ready to submit documentation that the neurogenic bladder is in fact due to the Cauda Equina Syndrome, regional home health intermediary Palmetto GBA instructs in its February 2004 Part A Advisory.

The RHHI says Cauda Equina Syndrome is caused by any narrowing of the spinal canal that compresses the nerve roots below the level of the spinal cord. These causes can include traumatic injury, disk herniation, spinal stenosis, spinal neoplasm, ependymomas, inflammatory conditions, infectious conditions and iatrogenic causes.

The Centers for Medicare & Medicaid Services confirmed in the Jan. 14 Open Door Forum that its Dec. 11 letter to surveyors should protect HHAs threatened with deficiencies after they followed former CMS Administrator Tom Scully's Nov. 5 instruction to discontinue OASIS data collection for non-Medicare, non-Medicaid patients. The letter made the suspension effective Dec. 8, and told surveyors to suspend pending findings against agencies over the matter.

The next quarterly update for the Home Health Compare Web site, which compares agencies' patient data on 11 outcomes, will be on March 4, CMS said in the Jan. 14 forum. The last update was in Jan.

CMS has expanded the nursing home quality initiative by revising and increasing - from 10 to 14 - the number of patient outcomes displayed on the Nursing Home Compare Web site. Experts predict HHAs can expect similar changes in Home Health Compare, although probably not before the first annual review next fall.

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Consider Carefully Before Putting ICD-9 Code 344.61 In M0230
If you don't have documentation to support case mix code 344.61, expect a denial, one [...]

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