Understanding M1010

As a coder, understanding the purpose of M1010 may not be so clear. Many times clinicians enter diagnosis(es) into M1010 that are not appropriate.

M1010 allows for a more comprehensive picture of the patient’s condition prior to the start or resumption of home care.  The key to understanding M1010 is knowing that the diagnosis(es) entered in this item include only diagnosis(es) that were “actively treated” in the inpatient setting within the 14 days preceding the date of the assessment M0090.   “Actively treated” should be defined as receiving something more than the regularly scheduled medications and treatments necessary to maintain or treat an existing condition.

Things to remember:

• Avoid the use of symptom codes if possible.
• No V or E codes should be listed in M1010.
• Only conditions receiving something more than the regularly scheduled medications and interventions should be listed in M1010.

 

Proper Use of M1024

If you are a newbie to home health coding or a seasoned professional, you may still have some trouble comprehending the proper use of M1024. What exactly is M1024? M1024 is used to prevent the loss of case mix points when an underlying case mix diagnosis is displaced by a V-code.

A diagnosis can only be placed in M1024 when there is a V-code listed in M1020a or M1022b-f. This slot is optional, therefore, agencies are not required to code a numeric diagnosis in M1024 if a V-Code replaces a case mix diagnosis code. Diagnoses listed in M1024 can only be a case-mix diagnosis that is resolved or a diagnosis that is part of one of the case-mix loss groups. The case-mix loss groups are Diabetes, Skin 1, and Neuro 1. If a V code is listed as primary and it is displacing a diagnosis in one of these categories, the diagnosis should be listed in M1024a and also in M1022. The diagnoses are termed case-mix loss groups because the diagnosis are given more points when reported as a primary diagnosis opposed to a secondary diagnosis.

Use the following guidelines to help you determine whether or not you should place a diagnosis in M1024a:

1. *M1020 (primary diagnosis) is an approved V-Code
2. The V-code displaces a numeric case-mix diagnosis that is resolved
3. If the numeric case mix diagnosis is not resolved, it is included within on of the HH PPS case-mix loss groups:
   • Diabetes
   • Skin 1-Traumatic wounds, burns, and post-operative complications
   • Neuro 1-Brain Disorders and Paralysis

*In order to determine whether or not the V code which is displacing a case-mix diagnosis is an approved V code, you need to refer to this V Code Table. (If the V code in question is not listed in this table, there is no need to enter a diagnosis in M1024)