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What’s In An ICD 10 Code?Do You Write Care Plans For 3 Digit Codes When The Diagnosis Is 7 Digits Long?


An ICD 10 code is more than just a few digits on a 485. We may know this from a reimbursement standpoint, but not always consider it from the clinical end. I’m going to age myself a bit and rewind to a time when nurses did their own coding which basically consisted of 3 digits. Congestive heart failure was congestive heart failure and I still remember the code. It was 428. Just 428. That was fine. Remember those days? The question today is whether or not your agency looks at a care plan according to the specificity that is now in ICD 10?

Wait, 428 Is Now 150.9?

In most cases, to accurately communicate specific heart failure requires 4-6 digits. So, if the code itself requires change, what should that do to the care plan? When you look at possible codes for heart failure, you may see the following: systolic, systolic and diastolic, congestive, acute or chronic, left or right, end stage, bi-ventricular, and peripartum to name some. When you think of the care plan, does end stage heart failure look just like the acute diagnosis?  Too often, the answer is yes.

So, What’s Next?

If the answer was yes, then it is time to change your agency care planning. As an agency, you need to consider 2 things. Make sure coding is accurately done by certified coders. Nurses do not have the time or direct expertise to be expert coders. They should be spending time in the field with the patients completing hands on care to ensure outcomes. If your agency employs a certified coder who is a nurse or otherwise, that is great. You need to consider outsourcing when you cannot justify a full time certified coder or would need several to meet your needs.

The next consideration is what is currently in your electronic medical record. Many agency have developed care plans specifically to address heart failure. It requires a checked box from a nurse and the care plan comes up for a patient with CHF regardless of the ICD 10 type of failure. Make this a potential within your CQI team to develop care plans to address disease process specificity. Or, get rid of the canned care plans in the system and focus on what is very specific to that patient. If you have an active heart failure, then have the nurses click only what is relevant at admission or as progression of the care plan is made. Reality is, there may really be 6 true interventions that are the focus for that episode. 25 makes for a pretty looking care plan, but how many interventions are specific to the patient and relevant?

Everything Starts With The Right Code:

At Kenyon Homecare Consulting, we focus on high-quality, patient-focused, outcome-based care. We help agencies reach their goals through education, operational change, coding, billing, and interim management. Regardless your homecare, home health, or hospice needs, we can help you reach clinical and financial goals. If you are unsure about your coding accuracy or how to begin changes to careplanning, give us a call at 206-721-5091 or contact us online to see how we can help you. We will provide a free 30-minute consultation with a senior associate and 5 free ICD 10 recodes of your current Medicare charts. Make sure your agency is hitting the mark as opposed to missing the target with coding and care planning.

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