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Know Your Numbers Part 3 – ICD-9 Coding

Although there is much more to legitimate and strong scores in PPS, it is impossible for a home health agency to thrive without adequate coding. In the chart below, we can see how a provider is scoring in the clinican domain over the course of six months. Remember, this chart says nothing about therapy or the functional domain. Only the questions in the clinical domain are counted.


The first thing you should know about the chart is that the three heavy horizontal lines represent the 10th, 50th and 90th percentile of multiple clients across the United States. This agency was scoring well above the 50th percentile range in March and April of 2008 but since then has hovered around the 10th percentile. Why? Did their patients change? Or more likely, did their staff change? These numbers beg questions and there may be reasonable answers indicating that the numbers are exactly where they should be. Only the agency can make that determination.

While it is impossible to make a truly knowledgeable determination without reviewing the clinical records of the agency, if I were a betting person, I would gamble that the ICD-9 coding is not where it needs to be.

How do you make that determination? You have to know your numbers. More importantly, you have to know how to work with your numbers.

  • Invest in coding skills in your agency. Some people take to coding more than others. It is like a puzzle to them. Take advantage of these people. Looking at the above chart, you can easily see how an agency would get a hearty return on investment by sending staff to coding classes.
  • Buy only the best coding books available. My personal favorite is the one by Decision Health. Regardless of which coding book you use, it must be introduced to the staff so that they can learn how to use it effectively.
  • If you have no coding talent in your agency, think about using a professional coder. Lisa Selman-Holman offers services for agencies that are paid by the clinical record. For a week or so, compare how a professional coding company performs next your agency’s internal efforts. It may be that your agency is doing a fine job but without specialized knowledge in coding, how do you know? Click here for more information.


The stark truth is that you cannot manage what you do not know. Having a working knowledge of ICD-9 coding and its effect on your agency is one more step to knowing your numbers.


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