Do you remember hoping for a magical decoder ring at the bottom of a cereal box? I do and to this day, I haven’t found one. The good news is that you don’t need one even though it would be fun.
I have a stack of denials on my desk and nobody was more surprised than me when I realized that the denial reasons were related to the Face-to-Face documentation. The reviewers noted that the visit documentation was within the time frame, signed and dated by the correct provider, but the claim remained denied because the agency plan of care was not related to the reason the patient was receiving services. I hate it when someone goes to the trouble of telling me how close we were but missed by an inch.
Here are some of the reasons given.
- Diagnoses from the initial plan of care are static regardless of how long a patient is on service. Well controlled hypertension after a couple of weeks will not get you paid even if it’s your blood pressure that’s high. Be careful not to change diagnoses just to change them. Some diagnoses such as wounds may remain primary.
- Similarly, some patients are readmitted after being discharged in the past and the plan of care from the prior admission is pulled up and copied without attention to the coding.
- Sometimes, the wrong primary diagnosis is chosen. Remember that nurses do not learn diagnosis coding in school. The tendency is to choose the worst diagnosis suffered by the patient but it may not be the reason the patient is admitted to home health. Consider the patient who is paralyzed and has pressure wounds because they are confined to a wheelchair. Paralysis is a very troublesome condition but you can’t do much about it. Wound care may be a more appropriate diagnosis. Other diagnoses like diabetes and hypertension have so many options that it can be difficult to discern the correct diagnosis as well as the sequence.
- Often patients are discharged from the hospital and the reason for the hospitalization is resolved or the physician or biller at a clinic does not code like home health does. Remember that we are instructed that the primary reason for home health must be related to the Face to Face document. The diagnoses need not be identical and often, copying the clinic or hospital diagnoses results in a poorly coded plan of care. Diagnoses like Diabetic Coma in an awake and alert patient are often questioned. In order to ensure that the Face-to-Face document relates to the reason for care, the document must be read thoroughly. Call the MD if there is any doubt if a patient has a certain diagnosis.
Regardless of whether your agency does the coding or it is outsourced, coding is an expense to the agency. Agencies with a corporate entity may decide to have in house coders. Agencies with one or two locations might consider outsourcing coding. Like everyone else, coders go on vacation, get sick and sometimes quit. That usually happens right after you pay for annual training which is necessary for your coders to keep up with changes to the codes. We are happy to help anyone with their coding. We can cover you when your coder gets sick or if you don’t know coding, review your coder’s work to ensure it meets standards. We don’t want you to be denied hard earned money for care given to patients who need it. Call 225-253-4876 or email us.