Below is commentary on the new Attachment D related to home health ICD-9 Coding provided by Vonnie Blevins, HCS-D. Vonnie is an active participant on the Home Health Coding listserv and truthfully, I have learned more about coding by reading her posts than most any other source. It is also rumored that Vonnie will be hosting a Decision Health Audio Conference later this month. Check back at our blog for details or email Vonnie directly at mime1lead@aol.com.

Everyone needs to read the entire attachment D  carefully and step back, take a deep breath and remember to follow official coding guidelines as well as the CMS direction.  The biggest changes in the Attachment D that I see are:

• If the case mix diagnosis meets current guidelines as well as being replaced by the V code, place it in M0240, not in M0246 In order to put a diagnosis in M0246, the case mix diagnosis must meet all of the requirements outlined in Table 2A and not be a current diagnosis (resolved)
  

• Any case mix diagnosis that is included must also be addressed in the plan of care (even the comorbididities that we have automatically coded before), but that should not be a big deal because we are generally at least monitoring these conditions and would notify the MD if there was a change in them, so we need to document this to cover these codes.
  

The attachment d update clearly states  avoid the practice of allowing the case mix status of a dx to influence the dx selection process. HHA’s are expected to prevent “coding for payment” from occurring.  Code only the dx supported by the pt’s medical documentation hh poc and clinical comp. assessment. if the dx under consideration is not supported by the pt’s medical condition and clinical care needs, then the dx must not be reported on the oasis.

• The Attachment has a error in listing Neuro 3 when it should be Neuro 1 as the third diagnosis category that gives more case mix points when listed primary versus secondary diagnosis

• The joint replacement is a bad example because the osteoarthritis in the replaced hip is gone.  To use the osteoarthritis diagnosis in M0240, I think we would need clarification from the MD that the patient still has osteoarthritis in other areas of the body. If the condition is resolved then we do not code it in mo240.
  

in a nutshell

only use mo246 if the condition is resolved and will not be in mo240 and meets the criteria to receive case mix points (example appendicitis),  if not documented as resolved then still code the condition in mo240 (ex. CAD 414.00) and if a v code replaced a neuro1/skin1/dm diagnois in mo230 put that dx in mo246.

address comorbidities – things like monitor 02 stats due to COPD/ assess c/p status/monitor/teach hypo/hyperglycemia/ monitor bs log due to dm/ things like that to address them. it has to show on the poc how you are monitoring or treating these dx to receive the case mix points for them.

The big thing is to make sure you understand table 2a and b and know when the dx meets the criteria for case mix points so you will know when to put them in mo246 if they are resolved and not in mo240.

VONNIE P BLEVINS HCS-D
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