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ICD Coding

Master Your ICD 10 Coding And You Master Your Home Health Program! Maximizing Your Reimbursement And Outcomes All At The Same Time!

ICD-10 CodingICD 10 coding is complex.  It is detailed and specific.  So are the patients that have the diagnoses attached to those codes.  Make sure you take a look at how better coding makes your program better overall.

5 Ways Maximizing ICD 10 Coding Can Mean A Better Overall Program:

First and most important you need coding done by those certified in ICD 10. So, that being said, here are 5 ways to make the most of your diagnosis codes.

1. More Specificity:

A good example of this is congestive heart failure.  ICD 9 used to use a more generic code, but now ICD 10 coding requires the specificity of what type. Looking at the type and patient specific causes means that the clinicians can have a better understanding of what to expect from the patient.  This would include the classes of the disease that determine severity.  This leads into our next reasons for improvement in your program.

2. Patient Specific Intervention:

By knowing the specific diagnosis, clinicians can better make patient specific care plan interventions.  Your interventions for someone with a class 1 CHF are different than those for a stage 3.  Realistic care planning is the only way to improve patient outcomes based on what is specific to that patient.

3. Patient Specific Goals:

Along with intervention, goals need to fit the diagnosis attached to that individual. A class 3 or 4 heart failure patient is not able to complete physical activities without shortness of breath. This may seem like common sense, but it is not uncommon to see goals that are not attainable for a patient regardless of compliance to care plan.

4. Painting A Clearer Picture:

In order to be able to code properly, documentation needs to be clear.  Certified coders know what needs to be present to justify codes as well as Oasis information.  ICD 10 coding requires more information and collaboration between home health and other providers.  Having the proper information in the patient record leads to painting a clearer picture for each clinician that enters the home.

5. Getting the Proper Reimbursement:

Don’t ever leave money on the table you are entitled to receive.  If you have the documentation and use the appropriate coding, you will receive what you need to care for the patient.  If you don’t, you will provide proper care and go in the whole every time.  That is not the intent.  Proper care planning and coding should provide what is needed to take care of the patient and keep you in the black at the same time.

Many agencies have the nurses coding while doing everything else.  Nurses cannot be the experts in coding and be expected to focus on patient care too.  Coding done by non-certified coders can mean up to $1,000 less per episode of care dependent upon the individual patient.

Let Us Help Turn It Around:

At Kenyon Homecare Consulting, we work with agencies on organizational assessments and process changes to maximize overall operations.  We provide coding services and in-depth on site education to nurses both in and out of the homes to help with Oasis accuracy and documentation.  Call 206-721-5091 or contact us online to receive your 30 minute free consultation.  Let us make a difference for your agency.

Yoda Was A Very Wise Member Of The Force. Is Your ICD 10 Coding An Asset Or Is It Holding You Back?

timeYou remember seeing Star Wars when Luke Skywalker was with Yoda learning about his role and becoming Jedi the was destined to be, right? When it comes to home health and ICD 10 coding, diagnoses need to truly drive your care plan and make sure you get the reimbursement you deserve.

5 Ways To Evaluate Your Current Program:

As an administrator, you should evaluate your coding for accuracy.  Here are some ways to see if you are on your way or need some work.

1. ICD 10 Coding Certification:

Whether you code in-house or outsource, make sure the coders are certified.  In addition, it is really important that the coders you use have home health coding experience. There is a big difference in the relevance of certain codes dependent upon the setting and where the patient is in the cycle of the illness exacerbation.

2. State And National HHRG Comparison:

Check your state and national averages.  If you are significantly higher or lower, then you need to take another look into accuracy.  You never want to leave money on the table you are entitled to receive caring for the patient. On the same hand, very high HHRG numbers mean you need to make sure you have the documentation to back up the Oasis and codes.  If there is a mismatch, you need to re-evaluate.

3. What Is Your Back-Up Plan?:

Can your current coding system accommodate significant influx of patient admissions?  If you complete coding in-house, can you cover workload if one would terminate employment or go on extended medical leave?  Consider having a contracted agency on hand to help during times of increased census or leave of absences.  It will assist in cash flow management as billing will not be hindered by Oasis and coding review.

4. Check And Balance Systems:

Whether in-house or outsourced, it is always smart to check your current system against another objective source.  Have another coding provider re-evaluate 5 charts. Give yourself reassurance your current in-house staff is coding appropriately.  It can also alert you if additional education or documentation needs completed by staff.  It also helps with your back-up plan as you will have someone in place to cover should the need arise.

5. Ongoing Education:

Is your current coding system keeping up to date with changes as they occur? How do you know?  Discuss this with your current provider and ask how the provider knows when changes to coding rules have changed.  If you have coding in-house, make sure staff knows where to find updates. Make sure state and national resources are available for them to keep informed.

Let Us Re-Code To See If You Are On The Right Track!:

At Kenyon Homecare Consulting, we can help you with ICD 10 coding, Oasis review, and staff education.  Call us today at 216-721-5091 or contact us online and let us do 5 re-codes for free!

All ICD 10 Coding Is Not Created Alike. Why You Need To Make Sure You Aren’t Comparing Apples To Oranges.

ICD 10 codingAre you happy with your current coding solution?  How do you know if your agency getting all you need from your coding company?  Here are some things to look at with your current ICD 10 coding.

Do You Receive The Data You Need?:

Let’s face it; some of your nurses are great with documentation and some are not.  Some really put all the pieces of the Oasis tool together properly and some are not the best at completing it accurately.  You may potentially know, but may not have the actual data to back it up. You may have a more cost-effective coding solution, but it may not include accurate Oasis review and allow you to complete focused educational efforts with staff.

Look at data that will be most important for your agency and address these items with the coding company directly.  This will allow you to get reporting you need to make informed decisions on who should complete admissions.  Ask your coding company to supply the numbers for reimbursement before and after the coding and Oasis review are complete.  Ask if clinician accuracy can be reported as an overall percentage. You also may want to receive a breakdown of error by questions.  These are items that allow you to trend information. If you have clinicians with a low error rate on Oasis submission, you can eliminate the need for your outsourced company to need an entire Oasis review.  You would save money if only need the ICD 10 coding needs completed.

How Do The Reports Look?:

Clinicians in the field are busy.  Having reports that are easy to interpret make life much easier for those in the field.  If it is easier for the nurse to review, then it is easier to make the necessary changes.  Often times, agencies will have a coding solution in place, but no way to determine if incongruities in documentation are updated appropriately.

How Does Your Provider Handle Times When Census Fluctuates?:

Home care has always been cyclical.  Some months have higher admission rates. If you complete ICD 10coding and Oasis review in house, it may be tough for you in the summertime when everyone takes vacation.  Do you have a back up? Make sure that whoever completes your coding and Oasis review can manage additional influx of patient admissions.  You need a solution that will not hold back your ability to bill the RAP in a timely manner.

Let Us Give You A Side By Side Comparison:

At Kenyon Homecare Consulting, we have ICD 10coding solutions that help with Oasis education and review.  We can complete 5 re-codes of claims to see if you are getting what you need from your coding supplier.  We can also be a back up for your agency if in-house staffing changes and you need additional assistance.  Call us today for 206-721-5091 or contact us online to see if we can help!

Winning the ICD 10 Coding Battle: Read This To Get The Most Out Of Your Coding And Improve Your Documentation In The Process!

codingIt isn’t new to any home care agency that ICD 10 coding is important.  But, depending on how many Medicare patients you have, you may not have paid a whole lot of attention.  Here, we take a look at why you can’t afford to dismiss even the smallest of Medicare census in coding.

ICD 10 Coding Changes Over Time:

Many remember “the good old days” of home care when the codes were put in, but reimbursement wasn’t tied into any of it.  Agencies were paid by the visit and although the codes needed to be right, it was not a complex process.  In many cases, the nurses looked up the exact codes based upon the information from the MD about the diagnosis.  Today, it is a whole different ballgame!

Now, codes are longer and the days of 3 digit codes are done.  When ICD 10 coding hit the healthcare industry, the need for certified coders to work with agencies became a necessity. You have been dealing with codes being linked to reimbursement for years now.  But, as the complexity of the Oasis and the codes increases, so does the need to make sure the codes are correct.  Therefore,  make sure you don’t leave money on the table.

Do Not Dismiss Coding Even If You Only Have A Small Medicare Census:

CMS is always collecting data.  Agencies need to remember that the Oasis tool is for data collection, so incorrect data hurts the industry in the long run as regulations continue to evolve.  Many agencies that service mainly the Medicaid population don’t spend much time with coding.  This hurts the agency financially too.  In these agencies, it is common to see nurses complete coding themselves.  Or, you may see an office staff person do it.  They are either self-taught or have taken a class here or there. The payment difference in this scenario is hundreds up to a thousand dollars different on an average Medicare episode.

Coding changes and clarifications are made sometimes monthly.  It becomes important for agencies completing in-house coding to be plugged into education more than once or twice.  It needs to be ongoing.  With the updated COPs, nurses are handling more in homes than ever before, and so it is not realistic for them to be experts at coding too.  Along the same lines, the office staff that completes coding as well multiple other job responsibilities will not have the time to dedicate to proper coding and Oasis review.

The Coding And Documentation Must Go Together:

As previously stated, Oasis is a data collection tool for CMS. This is a plain and simple fact.  Over time, the data is analyzed and changes are made to the tool and reimbursement based on previously collected data.  So, it makes sense that poor data can lead to changes that are not the best for your industry.  Investing in someone to complete the Oasis review and teach staff proper completion is a small price to pay to get the proper reimbursement back.  It also makes sure your documentation matches your coding.  The two items must go hand in hand to be right and capture the data you need in your patient charts.

Call Us If You May Need Help:

Kenyon Homecare Consulting offers to complete 5 re-codes of Medicare charts to see if your coding and documentation is on point.  We complete on site and virtual teaching to help those agencies improve documentation from the beginning.  Call us today at 206-721-5091 or contact us online for your free consultation!

You Know ICD 10 Coding Is Important, But Do You Know If You Are Doing It Right? Without A Check And Balance In Place, You Could Lose An Arm And A Leg!

ICD-10 CodingSo, you know coding has become more and more complex over time.  You know that improper ICD 10 coding means you potentially leave money on the table.  It is also no secret that care plans need to follow proper diagnoses.  However, have you ever checked your own coding process to make sure you are on the mark?

In-House ICD 10 Coding:

When you have your own coding in-house, several things that are often taken for granted.  Here are several items to consider to make sure you get the most from coding in-house.

1. Education:

So many home care agencies have staff on board coding who are not ICD 10 coding certified.  Individuals doing the coding are self-taught or have attended a few webinars on coding.  With the complexity of coding, this just doesn’t do your agency justice.  It is not uncommon to see these agencies using a lot of non-specific coding and missing out on justified increases in reimbursement.  Plus, home health coding is different from inpatient, so these individuals need to have education specific to coding in home health.  Look at your agency compared to the state and national averages per episode and see where you rank.  You may see a huge difference in what you are missing.

It is also important to consider where your coders will get ongoing education as changes occur.  ICD 10 coding is not something that can be taught one time and then the employee be good to go.  The employee must be in contact with sources that communicate changes to coding as they occur.  This is often from CMS or organizations dealing specifically with training on ICD 10 coding.  What is supposed to happen today is often the opposite of what you will code in 6 months, so you must keep on top of the changes as they occur.

2.  Side-By-Side Comparison:

It makes a whole lot of sense to have an outsources company on hand to help you in times of increased census or to cover employees who are on medical leave or extended vacations.  Coding should not hold up submission of claims.  It also makes sense that even if you have certified coders on staff that you check to see what comes up with someone else looking at those same charts to see if there is a difference.  It is a reassuring feeling when you  know your coders come up with the same findings as someone on the outside.  If you find a deficiency in your current coding process, it allows you to address it  once you have the objective data.  You may decide it isn’t helping you to have coding in-house and you want to outsource.  You may also decide you just need to invest more in keeping your current in-house coders up to date.

3. Are Necessary Changes To Oasis And Coding Being Completed:

There is often a struggle between coding and nurses and to what one thinks the answer to questions should be versus what the coder sees in the documentation.  The coder can only see an answer an Oasis question based upon what is in the documentation.  So, if a discrepancy exists, it needs to change.  Often times, nursing staff will not want any changes done to his/her work.  However, the coder only finds the discrepancy is there is one.  Although the nurses are the professionals in the field, you cannot minimize the expertise of the coder to interpret the documentation from the nurse. You may find that your agency has certified coders that make recommendations, but the nurses never approve the changes.  In these cases, no one has been  helped to submit a more completed chart that is eligible for better reimbursement.

What About Outsourced ICD 10 Coding:

Many agencies do outsource their coding and there are great coding programs out there.  However, if the reports are not easy to read and show you what needs changed, chances are it will not be changed.  It is not uncommon for us to see episodes of care with a range of $200-$1000 from poorly done in- house or outsourced coding.  You should consider someone outsourced that provides Oasis teaching and can show you reporting in a matter that is easy for you to understand the changes and why they need to be made.  Give it a shot and see if your current system is what you need.  Try it for a back up when your coders are off or you have had significant influx of patients to make sure that revenue cycles are not affected for you.

We Can Be Your Complete ICD 10 Coding Provider:

At Kenyon Homecare Consulting, we have service that will code and teach staff along the was on how to answer the OASIS questions and partner to make coding match the documentation.  We also have the ability to take it all the way to billing should that be something you need in your agency.  Give us a call today at 206-721-5091 or contact us online for your free 30 minute free consultation to see how we cam help you succeed with coding.

ICD 10 Coding Is Not Part Of The Care Planning Process, It Should Drive The Whole Thing! Why ICD 10 Should Be The Meghan To Your Prince Harry

OK, a wedding means the day when two things become one.  In the world of documentation and ICD 10 coding, it should be the same.  If you look at your agency, it there a mismatch between the two? Let’s look at how ICD 10 coding should drive the care plan.

Are Operations Backward?:

Usually, nurses make the admission visit and determine the care plan prior to the coder ever getting hands on a chart.  Think about that for a second.  Specificity of ICD 10 is there for a reason.  The goal is to delve more into the diagnosis and make the care plan more specific to the patient.  So, if the care plan has been finished before there is any deep dive into coding, how can a care plan function the way it was created to do so?

Do You Need Care Planning 101?:

Let’s go back to basics now. It seems with all the regulation changes, Oasis revisions, and EMR tweaks, nurses have to spend more time making sure every word is in its right place instead of getting a care plan to function as intended.  For you administrators who are nurses, remember doing those long care plans in nursing school?  If you missed one thing related to the patient assessment, you did it over.  It seemed like a redundant process then, but it makes so much sense now.  You looked at the patient based upon the head to toe assessment and the pathophysiology of the diagnosis given by the physician.  They went hand in hand.  The care plan had what signs and symptoms to assess for and appropriate interventions for the diagnosis.

How Does Your Agency Code?:

Do you have certified coders on staff? Do you outsource?  Or, are your nurses coding for themselves?  Bottom line is, nurses cannot be full-time clinicians in the field and be accurate certified coders at the same time.  This is expensive and time-consuming for an agency especially at a time when the industry needs more field clinicians. Do your clinicians use the data given in coding and Oasis review to its potential? If not, maybe it is time to rethink your process.  Those certified in coding, whether in-house or not, do not claim to be nurses.  However, they are the experts in coding and documentation.  They are highly trained to look for specific things related to specific diagnoses.  Consequently, if nursing dismisses the specifics of the coders expertise, a diagnosis may not be optimized and care plans will not be specific.

So Where Do You Go From Here?:

Take a good look at operations.  How do your clinicians respond to coding and Oasis review? How many times do coders recognize inconsistency in Oasis and documentation that are never addressed.  If you can honestly say it is pretty often, you are probably leaving money on the table and minimizing outcomes. In addition, coders should always be seen as an Oasis teaching tool.  A good coder is worth far more than his or her cost.   Sometimes an agency will get in the rut of thinking things have always been a certain way and so it should not change.  It doesn’t go that way in the world of healthcare.  Working to change old habits are hard but they can absolutely be done and even with long time staff. You may need an educational program to initiate change or an alteration in your current coding system.

We Can Help:

Do you need help restructuring your process?  Are you looking for certified coders to do your coding?  Do you need coders that can teach staff effectively on Oasis and work to make care planning match the patient need?  Maybe you lost a biller and coder and need help with the whole thing.  Kenyon Homecare Consulting has a robust coding and documentation program.  Call 206-721-5091 or contact us online to receive your free 30 minute consultation.  You may not know what you are missing.

Documentation And ICD 10 Coding: Why They Are The Danny And Sandy Of Home Care

icd 10 codingWe all remember wishing and hoping for the ending we got in the movie Grease.  Danny and Sandy coming together in the end and our favorite mismatched couple riding off into the sunset.  ICD 10 coding and documentation work the same way.  They must learn how to work together to become that perfect couple.  Let’s look at why the reference to the film fits here.

ICD 10 Coding:

We look back on the simpler time when ICD 9 was around.  Just a few numbers told the story.  Nurses could code themselves, for the most part. Then, the industry is hit with ICD-10 coding and the next level coming with ICD-11.  At first, it may feel like just a way to complicate things.  However, it is a transition to make things better.  Having a better understanding of diagnoses paints a better picture of patient status and should allow clinicians to create more specific care plans.  This is the bottom line.


Reality is, ICD 10 coding cannot be correct and specific if the documentation isn’t there to back it up.  Nurses aren’t nurses because they love to document.  And, consequently, it is sometimes difficult to communicate why documentation is so important for coding and patient care.  If you speak to nurses, many will say verbal report is more important than information derived from the patient’s chart.  Why is that? Well, because most can communicate the nitty-gritty of what the next nurse needs to know much quicker than it is to review page after page of documentation.

Putting It All Together:

Ultimately, the most accurate codes and care plans come from complete documentation.  So, the goal is for the two to paint the picture of what is really going on with the patient.  Look closely at the coding process for your agency.  Do you outsource? Does the outsourcing company give you information you need to improve clinician documentation?  Does the clinical documentation back up the codes on your 485?

Now, if you complete coding in-house you also have questions to ask. Are your coders certified?  What type of check and balance is in place to evaluate efficacy?  Do you, as an owner, know that the documentation in the chart backs up the codes you are billing?  You may have the most dedicated clinicians that take the best care of patients. You may also have really good coders that code according to the documentation they receive.  The goal is that we need to dig deeper.  Look at whether or not the two entities are complete.  We need to analyze documentation to evaluate if those in charge of coding receive all the tools to code properly.

Take a close look at your HHRG codes.  Where do you stand in relation to your state and the nation?  Are they below the average, but the patients need a lot of service.  The mismatch has to come from somewhere.  You may want to complete some side by side coding to see if your coding staff matches an objective outside source.  If so, you can rest easy knowing you are at an optimum coding level.  If you outsource, you may want to have another vendor code to see the same.  In addition, outsourcing companies that do not provide education of documentation mismatches don’t help your agency improve.  There is a lot to consider.

Kenyon HomeCare Consulting:

We can help you look at your documentation and coding to see if you are getting all you need from both.  Our goal is to help you improve patient care by optimizing care plans, coding, and ultimately, reimbursement.  Call Kenyon Homecare Consulting today or 206-721-5091 or contact us online to receive your free 30 minute consultation.  We can do side by side coding and re-code 5 charts for free to see if you are on the right track.

Strategies For Educating Staff On ICD 10 Coding

ICD 10 CodingCoding education is as important as coding itself. With lots of ICD 10 coding updates, you cannot fall “behind the 8 ball” on staff education. Remember when ICD 10 coding started? Industry experts said all staff, not just coders, needed to learn the new system.

Options For Training And Re-training Your Homecare Staff

Whether updating on ICD 10 coding changes or Oasis, staff education is key. Some options for staff training include:

  • Regular staff meetings/ announcements and basic procedural training.
  • Hands-on practice coding sessions.
  • In-depth education on documentation for clinicians and coders
  • Distance education on coding, documentation, OASIS, and other related topics.
  • Developing your own “arsenal” of high-quality training and staff education tools.

Lighten The Training Load By Outsourcing ICD 10 Coding

Education and re-training staff is ongoing. Documentation will always be a part of client care. Outsourcing coding reduces the training load.  You will no longer have to keep in-house coders up to date or train new hires. Your outsource partner can take care of it for you. Outsourcing ICD 10 coding can produce extra revenue. You can reinvest the savings in training nurses and other staff. Staff will have more time for client care.  This, as a result, can lead to happier and loyal staff members. This also improve client care, agency’s reputation, client retention, and new growth.


Staff education helps your homecare agency provide better care.  Correct coding paints the picture of client needs. Consequently, it will improve revenue and cash flow when done efficiently. Investing in coding education is one path, while outsourcing is another. Each homecare is different, so the solution will vary. To learn more about coding and staff education or coding outsourcing services offered by Kenyon HomeCare Consulting, contact us via our online form.  You can also call 206-721-5091 today for your free 30 minute consultation.


How to Make ICD-10 the Key to Positive Patient Outcomes

icd 10Many factors influence the outcomes and experience of your homecare patients, but ICD-10 coding is usually overlooked. The simple fact is ICD coding helps create better care. At first, it may not seem obvious, but if you “connect the dots,” you will see them impact!

The Path From Coding to Patient Satisfaction

ICD-10 is an extremely detailed and requires specifics to receive optimal reimbursements. Being specific means looking closer at the exact diagnosis for each patient. For example, instead of a diagnosis of “pneumonia,” ICD-10 has you look at details. Does the patient have aspiration pneumonia, congenital pneumonia, interstitial pneumonia, or pneumonitis. Further sub-codes identify causes, such as pneumonitis due to external agents versus due to fumes/vapors.

Correct coding goes hand-in-hand to form a TRULY individualized plan of care. Detailed diagnoses determine how many/what kind of interventions are necessary. A better care plan leads to better and boosts your patient satisfaction rates.

Further Repercussions of Optimized ICD Coding

There are other beneficial effects of “stellar coding,” including these:

  • High client satisfaction leads to client retention and “word of mouth” referrals.
  • Higher reimbursement rates improve cash flow.
  • Increased staff satisfaction with improved patient outcomes.
  • A firm grasp on coding details helps you better handle chronic disease management.

Improve Coding With ICD Outsourcing and/or Education

Given that coding is key to improved patient outcomes, a healthier bottom line, and a growing, thriving homecare agency, how does an agency improve coding?

There are two approaches to consider:

  1. Keep coding in-house but invest in coding and documentation training for all relevant staff.
  2. Outsource all coding to a 3rd party provider with deep expertise in home health & hospice coding specifically.

At Kenyon HomeCare Consulting, we can assist you by handling all your coding through our highly acclaimed Coding Plus Program or provide distance and on-site training for your in-house coders. We can also train clinicians to optimize documentation so coders can submit claims to CMS as quickly as possible. To learn more or to schedule a free consultation, call Kenyon HomeCare at 206-721-5091 or contact us online.

Why ICD-10 Coding Needs To Be Your Home Health Holy Grail

Many know “The Holy Grail” from a certain Charleston Heston movie which shall go unnamed (involving a final “crusade” for the magical cup). The holy grail is found to deliver happiness, everlasting youthfulness, and unlimited supplies of food and other necessities. What is the holy grail in home health? One good answer would be ICD-10 coding.

The “Miraculous Powers” of Perfect (or near-perfect) ICD Coding

The homecare industry is growing by leaps and bounds. This creates opportunities for home health organizations and saves hospitals and taxpayers up to 50%. Home health is a competitive sector, and unless you are reaching your reimbursement potential, your agency is likely struggling instead of thriving. The remedy many times is to maximize reimbursements via improved ICD-10 coding. Here’s how:

  • Rely only on certified, homehealth-specific ICD-10 coders. Experienced coders simply code better and faster. Hospital and home health coding are not the same language.
  • Invest in continuing education for coders and clinicians alike. If you code in-house, you know ICD 10 changes can be monthly! Your coders need to keep on top of it.
  • Keep your coders and clinicians communicating well.  Collaboration before, during, and after documentation means all the difference.

Consider Outsourcing ICD Coding (your grail) to Industry Experts

ICD coding is so important to the success of homecare. Coding in-house can be a burden. Management time spent coding decreases time for case management . It can be difficult to find, hire, and keep good ICD-10 coders. Even if you have a great coding staff, back up coders for extended vacations, medical emergencies, or if someone leaves unexpectedly is necessary. Plus, outsourced coding can both save you money on employee salaries/benefits and potentially boost reimbursement rates by 29% to 48%.

At Kenyon HomeCare Consulting, we can protect your “holy grail” with outsourced coding which can: increase revenue, improve turnaround time for better cash flow, and prepare you for increased growth since staff can focus on clients instead of codes. To learn more about our Coding Plus Program, continuing staff education offerings, and other valuable services, contact Kenyon today by calling 206-721-5091.