There’s More to Coding than Billing

Having spent the last 20 or so years in home health, I have absolutely no use whatsoever for an ICD-9 code other than billing.  As I nurse I don’t treat 401.9 or 250.02.  I treat people with hypertension or diabetes.  The only time a code is important to me is when it comes time or billing.  At that point, the code better be correct and accurately describe the patient.  In fact, my standard response to the oh so popular question, ‘Which code pays the most?’ is, ‘The code that most accurately describes your patient.’

So every once in a while some academic association or research group reminds me that ICD-9 and soon to be ICD-10 codes are used for tons of reasons.  Epidemiological studies and clinical research are often driven by coding.  I imagine that’s how they make those seasonal flu maps.  It’s probably easier than going state to state and taking a headcount.  The prevention and detection of healthcare fraud and abuse is one that some providers don’t take very seriously but many claims are chosen because of a diagnosis and some other factor.  It certainly doesn’t mean that you shouldn’t use the code because the best code is….. the one that most accurately describes the patient.  And the whims of CMS change.

As the government gets more involved in health care whether you think it’s a good idea or not, icd-9 codes will be pivotal to setting health policy.

In reading some of the studies presented to congress over the past several years that ultimately resulted in changes to our payment system, it occurred to me that if we had answered the OASIS questions correctly and coded the diagnoses properly, the changes would not have been as devastating.  It is hard to imagine that your codes will make a difference in the payment system five years down the line but if everyone thinks that way, the payment system will continue to reflect decisions made on poor data.

So make sure that all OASIS responses and codes are chosen with care.  If you have questions, you can ask them here and we will get back to you.  If your agency uses professional coders, make sure that  you give them the information they need to code.  We can help you with that, too.




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