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Navigating the Challenges of Coding Compliance

Posted on Wednesday, August 24, 2016 2:06 PM

Hospices are focusing their attention on a journey into coding compliance. Prior to FY 2013, hospices normally didn’t report one code on their claims. Now, the Department of Health and Human Services has submitted more regulations regarding diagnosis coding for hospices. With new federal regulations from the Centers for Medicaid and Medicare Services (CMS), there has been a need for explanation of hospice coding.

Acute Care Diagnosis Codes in Hospice?
There has been division between the hospice coding professionals regarding diagnoses that is typically seen in the acute care facility. The main concern is whether or not these acute care codes should be used in hospice.

Coding professionals cannot make assumptions or jump to conclusions. Therefore, the Coding Guidelines needs to be used as the primary source for review, especially when going back to the “basics.” Additionally, the Coding Guidelines provide use on "acute" care codes for particular disease processes, not for the location or facility using the codes.

7th Characters: Where Does Hospice Fit?
When it comes to pathological fractures, a 7th character is mandatory to complete the code.

The Coding Guidelines state, "7th character D is to be used for encounters after the patient has completed active treatment. The other 7th characters, listed under each subcategory in the Tabular List, are to be used for subsequent encounters for treatment of problems associated with the healing, such as malunions, nonunions, and sequelae."

Diabetes Assumption with HTN CKD Ruling for Terminal Patients
The Coding Guidelines state that coding professionals should assume a relationship between hypertension and chronic kidney disease (CKD). This ICD-10 rule was carried over from ICD-9. Recently, a new assumption rule was indicated by the Coding Clinic, stating that a relationship between diabetes mellitus (DM) and CKD should be assumed.

With all the confusion and questions surrounding ICD-10, the Coding Guidelines and coding manual notes are useful tools to review.

Finally, the ICD-10 Coding Guideline states," The importance of consistent, complete documentation in the medical record cannot be overemphasized. Without such documentation the application of all coding guidelines is a difficult, if not impossible, task." Hospices need to build a strong relationship with referral agencies to develop consistent documentation.

Corridor’s Coding Services offers ICD-10 coding, multi-level OASIS reviews, Clinician documentation review, as well as trends and reporting. Contact us to learn more.

The article was written by Shawna Zastoupil, RHIT. She is a coding manager at Corridor.

For the full AHIMA article, click here.

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