Review RAPs, final claims to ensure correct coding
There is no grace period for the new ICD-9 codes that go into effect Oct. 1, 2004, so home health managers and coders need to make sure they understand the effect of some of the new codes.
"The coding changes that most affect home health were made to increase specificity of the diagnosis," says Prinny Rose Abraham, CPHQ, RHIT, a coding consultant with HIQM Consulting in Minneapolis. "A more specific code is actually a good thing for the home health agency because it [more accurately] demonstrates skills needed and helps nurses prepare a more specific care plan," she says.
The greatest code change for home health will be the set of codes that are used for decubitis ulcer, says Abraham. "The code we’ve used [in the past is] 707.0 for decubitus ulcer with unspecified site. "The new five-digit codes specify sites and in reality, no home health nurse should have a patient with an unspecified site. We do have to know where it is to treat it," she points out.
The new codes for decubitis ulcer are:
- 707.00 — unspecified site
- 707.01 — elbow
- 707.02 — upper back
- 707.03 — lower back/sacrum
- 707.04 — hip
- 707.05 — buttocks
- 707.06 — ankle
- 707.07 — heel
- 707.09 — other site, including head
Because home health agencies use this code so frequently, and because agencies bill by 60-day episode, Abraham points out that billing and coding personnel need to be aware that the Request for Anticipated Payment (RAP) might have used the four-digit code that was in place at the time service was provided.
"This means that a final claim must be corrected to include the five-digit code if the final claim is submitted on or after Oct. 1," she explains. Agencies also have the option of running a report Oct. 1 to determine which RAPs included the old codes, and submit a corrected RAP, Abraham says.
Other code changes include:
• Venous embolism and thrombosis
The old code of 453.4 did not specify a site, she explains. Now, you use 453.41 to designate proximal lower extremity and 453.42 to designate distal lower extremity, Abraham adds.
• Obstructive chronic bronchitis
In 2003, this code was subdivided to 491.20 for obstructive chronic bronchitis without exacerbation and 491.21 for obstructive chronic bronchitis with exacerbation, she says. "We now have 491.22 for obstructive chronic bronchitis with acute bronchitis to better describe the patient’s condition," notes Abraham.
"Insulin-dependent and noninsulin-dependent were removed from the 250 category," Abraham points out. The words "adult onset" also was removed from the description because people were coding all children as Type I and all adults as Type II, regardless of the actual type of diabetes, she says. The change is designed to produce a more accurate description of the patient’s condition, she adds.
Abraham suggests that home health staff members get to know all of the codes that might apply to their patients because the more accurate claims are today, the more accurate reimbursement will be in the future. "The diagnosis data that we submit today will be used to create reimbursement policy. The more accurate the data, the more accurate the reimbursement will be."
For more information about coding, contact:
• Prinny Rose Abraham, CPHQ, RHIT, Health Information Consultant, HIQM Consulting, 5748 Russell Ave., Minneapolis, MN 55410. Phone: (612) 927-9813. Fax: (612) 926-0342. E-mail: email@example.com.
To see changes in the ICD-9 codes, go to www.cms.hhs.gov/medlearn/icd9code.asp.