Don’t Cheat Yourself

One of the most frequent requests we have is for Cheat Sheets of commonly used codes and combinations of codes.  We do not have one to offer you and we have no plans to offer one.  They really do sound like a great idea – we admit it – but they result in very poor coding, reduced revenue, denials and payment take-backs.  If you can get past all of that, maybe they are a good idea.

The Cheat Sheet concept skips the most important step in the coding process – looking at your code book. We prefer Decision Health’s Coding Manual.  Other coders have their own preferences.  Regardless of the book that you use, a true coder never codes without one. 

There are still agencies who have field clinicians do their own coding.   In hospice, it is rare to find anyone but the field staff coding.  Very few are nurses have have the training to code appropriately. In order to code well, you have to have the education and experience.  Like most other skills, repetition builds competence.  If a field nurse is doing one to two re-certifications and an average of four admissions per week, it is probable that inaccurate codes are being placed on your claims.  For this reason most agencies hire full time coders, outsource their coding or design a combination of both. 

On August 1, home health agencies will begin dual coding with both ICD-9 and ICD-10 codes, All claims for hospice beginning October 1 will require ICD-10 codes.  When ICD-10 is implemented, it will be near impossible to develop a cheat sheet that could be of even minimal assistance.  The number of codes will multiply as the focus of each code is narrowed considerably so as to leave no question regarding how and where the patient is affected. 

This means that in order to be ready for the August or October implementation date, agencies, including hospice providers must have in place a system that results in accurate coding.  Our preference is that you call us.  More important to you is simply taking the time to think about it now. 

If you will be using in house coders, invest in the training they need.  This is not a simple ‘translation’ process where you find a new code to replace old codes. There are new rules and conventions and it is grossly unfair to any coder to ask them to perform post ICD-10 implementation if you haven’t devoted the resources for education and the time for practice. If you are outsourcing, keep in mind that even the best coding company must fully integrate with your processes and there will be a period of adjustment.  Do you want that period to begin concurrently with ICD-10 implementation?

We have contracts with home health agencies and hospice providers that have in house coding so they can offload coding as needed because of backlogs, vacations, illnesses, etc.  This keeps their billing current and the agency has a chance to compare their in-house coding with the coding of a professional coding company.

Regardless of who you use, there are some decisions that must be made now while you have the time to pick and choose.  That is a much better use of your time than trying to create a cheat sheet for coding because we flat out refuse.  We’re too busy getting ready for ICD-10.

Hospice Coding

coding wordle 2


72 percent of hospice claims list only one diagnosis.  The diagnosis used most often is Debility. The third most frequently used diagnosis is adult failure to thrive. 

That means that upwards of 75 percent of hospices may have some real problems soon.  The requirement that hospices adhere to the ICD-9 coding guidelines is not new.  It is written into the original 1983 hospice guidelines and CMS is very much aware that hospices are not following the long established rules of coding.

Hospices have responded by building cheat sheets and lists of common hospice diagnoses.  It’s a great idea but it probably won’t work.  It didn’t work for hospitals in the 90’s or home health agencies after their prospective payment system was refined in 2008.  To this day agencies that depend on untrained nurses to code are losing money by insufficient coding or worse, getting denied because of invalid codes.

The biggest mistake that home health agencies made all those years ago after PPS was implemented was not taking coding seriously.  With four exceptions, the ICD-9 coding performed by an agency did not affect payment.  As such, diagnosis coding was not taken very seriously by home health. 

That turned out to be a mistake. Diagnoses that required significant resources to treat were not included in future updates to the payment system.  Incorrect, poorly specified diagnoses were included but when coded correctly, they did not add to the reimbursement.

I am not going to pretend that I am psychic and charge you for my insight into the future.  I can only say that I see this happening to the Hospice Industry in the not-so-distant future.

How could this stubborn insistence on following the rules be any worse, you ask?  It comes right as the rest of the world is transitioning into ICD-10 coding.  That’s right.  By the time you get the hang of ICD-9 Coding, the rules of the game will change.

It’s almost as though Medicare has taken up our cause as their own and has begun emphasizing the value of our coding services.  Thank you, Medicare for the plug.  Can we talk about the face-to-face requirement, now?

If you do not want to outsource coding, there are other options (but none as good as contracting with us or another reputable company).

  1. If your hospice has common ownership with a home health agency, remember that this is not new to them.  Make some kind of arrangement with them. 
  2. When you are recruiting nurses or billers, put coding on the top of the list of preferred skills.
  3. Go online and look for certified coders.  Remember, coders do not have to be nurses.
  4. If there is a school that offers RHIT certification in your area, offer a student internship.  You might end up with the employee of a lifetime or a dud.  It is worth the gamble because they are trained in coding, electronic health information, etc.   
  5. Outsource ICD-9 coding and focus on investing in ICD-10 coding preparation for your staff. 

Remember, people do not wake up one morning and try as hard as they can to thrive and fail.  If you cannot come up with a good underlying reason, expect denials.  Not being paid fairly could easily be the result of poor coding which might lead to a poor outcome for hospices that go the extra mile to ensure patients and their families are comfortable at the end of life.  It takes resources to provide the kind of care that matters.  Don’t cheat your hospice or your patients by failing to take this seriously.

As always, Delaine and Jackie can be reached via email or you can call 337-654-7934.