An ICD 10 Code By Any Other Name Is Not The Same. Make Sure You Are Maximizing The Use Of Yours!
October 19, 2021
Why The ICD 10 Updates Matter:
- There are changes to what is accepted as a primary diagnosis
- The changes are critical to payment updates under PDGM for home health
- Changes are key to hospice related versus unrelated problems in hospice coverage
- The changes reflect additional specificity necessary in documentation to capture specific codes.
- And, as always, there are discontinued codes or codes made invalid
PDGM Implications:
All things considered including the timelines in PDGM, Oasis and coding become the lifeblood of your agency cash flow. The PDGM case mix weights have been adjusted to accurately reflect utilization seen in each HHRG last year. If you get the diagnosis code wrong, then you lose payment. The ICD 10 codes affect all variables in the HHRG with the exceptions of admission source and timing. If you mark your Oasis wrong, then you potentially lose dollars. The payment is determined by most recent Oasis functional levels with associated diagnosis assignments.
What About A Significant Change In Condition Assessment (SCIC)?
Help Your Coder To Get It Right:
- Ensure all Oasis responses/ hospice comprehensive assessment data supports the diagnosis listed
- Avoid contradictions in the patient record
- Determine a "best-guess" diagnosis in light of: actual orders/ focus of the care plan, clinical assessment, interdisciplinary input , MD confirmation of diagnosis and approval of plan of care, and referral information
- Write a narrative that includes a description of your "best guess" diagnosis in your narrative
- Don't worry about anything related to the numeric codes. Your coder will find the best diagnosis based upon the information you provide.
Let Kenyon Home Care Consulting Be Your ICD 10 Coding HQ:
Results Based Consulting
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