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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.

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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