Coding: Aftercare for Fractures

Table 25 should ALWAYS  be referenced when coding fractures and aftercare in the home health setting The incorrect pairing of a fracture code with an aftercare code can cause reimbursement loss for your agency. Click here to view the table: Table 25 Fx and V codes

ICD-10 Fracture Coding Tidbit:

Coding aftercare for fractures in ICD-10 will not require the use of a  V code for aftercare. The fracture code is made up of 7 characters, with the 7th character notating the episode of care.

The 7th character options for each fracture code include the following:

A: Initial encounter for closed fracture

B: Initial encounter for open fracture

D: Subsequent encounter for fracture with routine healing

G:  Subsequent encounter for fracture with delayed healing

K: Subsequent encounter for fracture with nonunion

P: Subsequent encounter for fracture with malunion

S: Sequela

*Notice that the fracture codes will include laterality, open/closed, healing/nonhealing, nonunion/malunion, sequela (late effects)*

Example: Patient admitted into home health for aftercare of a right foot fracture.

M1010: S92.901A

M1016: S92.901A

M1022:  S92.901D

Analysis of Case-Mix Weights Per the Proposed Rule for 2014

HCAFeNews

The recent proposed rule by the Centers for Medicare & Medicaid Services included case-mix weight changes for 2014. An analysis of the 153 case-mix weights by John Reisinger of Innovative Solutions for Home Health found the difference between the 2014 proposed rule versus the current weights is -26%. 

View original post 103 more words

CMS Releases OASIS-C1 Draft

CMS has released it’s first draft of the OASIS-C1. This new assessment is designed to facilitate the transition into to ICD-10.

The draft has reduced the number of items from 114 to 110.  A few changes include:

  • Omission of M1012 (Inpatient procedures)
  • Omission of M1310, M1312, M1314 (length, width, and depth of largest PU) on SOC, ROC, and D/C.
  • Diagnosis slots have been expanded to support ICD-10 codes.

OASIS-C1 will be implemented concurrently with ICD-10, on Oct. 1, 2014. Read more…

Four Ways to Sequence Late Effects

Coding for late effects can be a bit tricky as there are multiple ways to sequence late effect and residual codes.  A late effect is a condition which appears after the acute phase of an earlier causal condition has taken place. Use our guide below to assist you when coding for late effects.

1. Late effect, generally

  • Hemiplegia as a result of a head injury
  • Residual deficit, hemiplegia: 342.xx
  • Late effect head injury: 907.0

2. Manifestation as a late effect

  • Late effect of polio: 138
  • Osteopathy: 730.7x

3. Late effect of CVA-combination code

  • Late effect code includes the residual deficit: 438.21

4. Late effect CVA combination coding

  • Late effect of CVA w/visual deficit: 438.7
  • Residual deficit, visual loss: 369.9

Follow us on Facebook and Twitter

Stumped over coding amputation complications?

Are you stumped over amputation complication codes? Let’s review key information regarding amputation complications.

Complications of amputation stumps include:

  • Dehiscence
  • Infection
  • Non-healing status
  • Neuroma

When assigning a code for an amputation stump complication, reference the following in the alphabetical index: Complication, amputation–the index will lead the coder to category 997.6x. Please note: an infection or dehiscence of an amputation incision is coded here and not with category 998.xx.

Phantom limb syndrome (phantom pain) and ulcers are NOT considered complications of a stump.

Reminder: Do not assign an additional code for the amputation site (V49.6x-V49.7x) if the site is complicated.

ICD 10: Coding amputation complications in ICD-10 will require the coder to specify the limb affected by the amputation e.g. upper or lower, right or left, as well as the the type of complication.

Home Health Agencies to Stop using Type of Bill 033x

HCAFeNews

The Centers for Medicare & Medicaid services has released change request 8244 that provides instructions for home health agencies to discontinue the use of Type of Bill (TOB) 033x and redefines TOB 032x to mean “Home Health Services under a Plan of Treatment.”

Currently, home health agencies use either bill type 032x or 033x on their claims for home health service provided under a home health plan of treatment.

TOB 032X and TOB 033x are defined as follows:

View original post 295 more words

Coding Myocardial Infarctions – ICD-10

An acute myocardial infarction (heart attack) results when there is an  interruption of blood flow to heart muscle. The heart cells become damaged or die. Many times, heart attacks are due to coronary atherosclerotic disease (CAD).  Heart attacks can also be caused by stress or physical exertion and severe infections.

Myocardial infarctions requires the coder to seek the site and type of infarction, as well as the episode of care.  The site  indicates the location in which the infarction occurred. The type of infarction indicates whether the infarction was ST elevated (STEMI) or non ST elevated (NSTEMI). ICD-9 currently classified MI’s to the 410 category with the 4th digit indicating the location and type, while the 5th digit indicates the episode of care.

Example: STEMI of the anterolateral wall, subsequent episode:

ICD-9-CM: 410.02

ICD-10: I21.09

Coding MIs in ICD-10 will be a bit different. The coder is no longer required to know the episode of care. MIs are classifed by site, type, and occurrence. Per the Coding Clinic, First Quarter 2013, MIs not specified as STEMI or non-STEMI should be coded as a STEMI by site.

ICD-10-CM Official Guidelines for Coding and Reporting, a myocardial infarction is considered acute for four weeks. In ICD-9-CM, a myocardial infarction is acute for eight weeks.

I21.4  is assigned for all NSTEMIs.

I22.4 is assigned for a subsequent NSTEMI, occurring within 28 days of a previous MI, regardless of the site.

Rest assured there is still a code for an old MI, I25.2.

And the winner is …

Congratulations to H. Strong from TX! She will be receiving a FREE copy of Instant OASIS Answers 2013. Thank you all for following our blog!

Don’t forget to visit our website for FREE CEU’s from the BMSC.

UPDATE: Palmetto GBA RAP Suppression

HCAFeNews

Palmetto GBA announced that it is in process of restoring RAP payments to agencies which have submitted Corrective Action Plans or Rebuttals that meet their requirements. If the provider is making strides in reducing the number of auto-cancels, is filing a majority of their finals timely when compared with auto-cancels, and are in good standing, Palmetto is restoring their RAP payments at 60% as new RAPs are received.

PGBA is also working on refinements to the RAP suppression standards that will be applied prospectively in evaluating the status of HHAs with auto-cancelled RAPs. The home care industry has recommended that the standards and process be revised to better target providers that present program integrity risks to Medicare. PGBA has already included one such refinement in its standards by considering the percentage of RAPs to final claims in evaluating rebuttals submitted by HHAs.

View original post 223 more words