OASIS Alert

Published on Wed Jan 05, 2005 PDF

You can't rely only on the case mix list.

If you've been worrying about coding dementia with Parkinson's, here's the answer.

More than a year after its appearance as a new ICD-9-CM diagnosis code, 331.82 (Dementia with Lewy bodies) is still confusing home health agencies. When the new codes debuted in October 2003, the coding manual directed coders looking for dementia with Parkinson's to 331.82, a newly created code.

But agencies became concerned about using that code because it was not listed as a case mix diagnosis in the Centers for Medicare & Medicaid Services' list. A case mix diagnosis gives the agency extra home health resource group points - leading to extra reimbursement - for a number of neurological, orthopedic and diabetic conditions specified in the final rule for the home health prospective payment system.

The case mix list was not updated to show any changes when the new codes appear-ed. And if you follow the instructions on the case mix list, you conclude that 331.82 is not included, explains coding consultant Lisa Selman-Holman with Denton, TX-based Selman-Holman & Associates.

Problem: This left clinicians in a quandary. Both dementia and Parkinson's disease are included in the list of case mix codes that add 20 points to the HHRG and at least $600 dollars to the episode reimbursement. If coders use 331.82 instead - as coding guidelines require - and it is not a case mix diagnosis, they lose out on that money, while still providing the more expensive care these conditions require, agencies say.

Good news: "We have checked and have confirmed that the grouper software accepts 331.82 as a case mix diagnosis," a CMS spokesperson tells Eli. Despite the fact that 331.82 is not included in the list of case mix diagnoses, it actually is one, the spokes-person confirms.

Editor's Note: For more diagnosis coding help, subscribe to Eli's Home Health ICD-9 Coding Alert by calling 800-874-9180. And check out the upcoming February 25 teleconference, "Savvy Solutions to Complex HHA Coding Cases," by coding expert Lisa Selman-Holman at http://codinginstitute.com/conference/conference.cgi?detail=214.