Sometimes we get discouraged because we seem to teach the same information over and over again. The fact is that many nurses in home health and hospice are new to the industry. Complicating matters is the fact that many of us have been around so long and are so familiar with OASIS and coding that certain that it is difficult to believe it is hard for the new kids on the block. If you are the new kid on the block, read carefully. If you aren’t the new kid on the block, read it and share. These five errors are common occurrences and there is no good reason for a good agency to leave this kind of money behind.
It is easy to miss the mark here. We see low vision coded with no supporting code, supporting codes without a low vision code and no codes for vision even though the patient is on three drops for glaucoma. Consider that a patient with low vision is compromised. Even when low vision is not actively addressed in the care plan, the patient will be at higher risk for falls, require slower teaching because they may not be able to read your teaching guides and are prone to medication errors. Even when a diagnosis does not meet the criteria for low vision, be sure that the patient’s visual acuity, or lack thereof, is fully documented. Remember, low vision codes require a supporting diagnosis that is not corrected with lenses or surgery.
The OASIS instructions for M1022 state that all diagnoses that affect the patient’s response or outcomes must be included in the secondary diagnosis list. Many clinicians are limiting their diagnoses to those that are actively being treated. Several denials have come across our desks where a reviewer actually includes the lack of orders and goals for a diagnosis as a reason for denial. Always refer to the OASIS Manual Chapter 3.
When determining which diagnoses should be included ask yourself if you think the treatment plan or the patient’s outcome would change if he or she did not have the diagnosis. Diabetes affects pretty much every system in the body and would always be included. GERD, maybe not so much. Low vision, Yes. Hypothyroidism, No. When the diagnosis really doesn’t affect the plan of care or the patient’s response to the plan of care, leave it off.
Too many diagnoses:
See above. There are some diagnoses for which an agency receives additional reimbursement that are put on care plans when they should not be. This puts the agency at high risk for denials. If a patient takes Nexium, it does not mean that they have GERD. If a patient is newly diagnosed and your care plan involves teaching diet and new meds, absolutely include it.
When a diagnosis is characterized by a symptom, don’t code the symptom. Arthritis is a condition that causes inflammation and pain of the joints. There is no reason to include pain. But, don’t forget to assess it, treat it and document pain in your notes of an arthritic patient.
A long time ago, someone told agencies that one reason they were being scrutinized is because the diagnosis codes never changed. That much is true. However, simply juggling the codes without any supporting documentation looks as though you rearranged codes to avoid having your patient look as though they were stable with no ongoing needs. If your patient doesn’t need you, discharge them. If your agency doesn’t like it, so be it. Move on. Do not be part of a culture that plays fast and loose with Medicare regulations.
Be sure to get with us if you have any questions or if you need any help with coding. We love questions.