Linking the Coding Process, the OASIS & the POC to Make Them All Work Together

Transcription

1 Linking the Coding Process, the OASIS & the POC to Make Them All Work Together Presented by Jennifer Warfield, RN, BSN, HCS-D, COS-C Education Director PPS Plus Software

2 Linking the Coding Process, the OASIS and the POC to Make Them All Work Together Linking the Coding Process, the OASIS and the POC to Make Them All Work Together Document Integrity The principle diagnosis on the 485 (Plan of Care) and the UB-04 must match to OASIS M1020 diagnosis. The diagnoses and the ICD-9 codes reported on each claim must match the additional diagnoses reported on OASIS item M1022 (Other Diagnoses). M1016 (M1016) refers to the diagnoses requiring medical or treatment regimen changes within the past 14 days prior to the SOC. List the diagnoses and the ICD-9 codes at the level of highest specificity. OR Use NA if no medical or treatment regimen changes in the past 14 days Item Intent Identifies if any change has occurred to the patient's treatment regimen, health care services or medications within the past 14 days. The purpose of this question is to help identify the patient's recent history by identifying new diagnoses or diagnoses that have been exacerbated over the past 2 weeks. This information helps the clinician develop an appropriate plan of care, since patients who have recent changes in treatment plans have a higher risk of becoming unstable. Time Points Start of care Resumption of care Data Sources/Resources Patient/Caregiver interview Physician Physician orders Referral information Current ICD-9 coding book Response Specific Instructions No surgical codes No V or E codes May be the same response as M1010 Past 14 days refers to the 2 week period immediately preceding the SOC or ROC 1

3 Linking the Coding Process, the OASIS and the POC to Make Them All Work Together Coding Guidelines M1020a/M1022b-f/M1024a-f Risk of upcoding or downcoding Improper sequence of diagnoses Lack of supporting documentation detailing reasonable & necessary care ICD-9 codes not coded to highest level of specificity Absence of symptom control rating OASIS Guidelines List one code for each diagnosis for which patient is receiving care Assess patient prior to coding Avoid the practice of coding for reimbursement Verify all diagnoses with medical records, physician or PCM (Primary Care Manager) Review all medications Review Process Who is reviewing OASIS, POC & visit notes? Procedure for corrections Codes not matching on all three documents will be RTP (Returned to Provider) May affect reimbursement due to upcoding or downcoding Under scoring or over scoring may lead to inaccurate HHC (Home Health Compare) data Therapy Documentation Completing documentation in timely fashion Is care medically necessary? Are subjective & objective goals being documented? Transient & easily reversible conditions Safety as the main component Defining skilled care Can therapist address medication & CHF issues? Physical therapists are more than capable of completing the drug regimen review item. It is within the scope of the physical therapist to perform a patient screen in which medication issues are assessed even if the physical therapist does not perform the specific care needed to address the medication issue. POC Should each diagnosis have an intervention? Must all medication have a diagnosis? Precise interventions and goals that are adjusted as needed Interventions need to be specific for each diagnosis Should all comorbidities be coded? 2

4 Linking the Coding Process, the OASIS and the POC to Make Them All Work Together Case Study Patient on service since 3/30/2005 for various comorbidities including HTN, DM, COPD, obesity and osteoarthritis. Diagnoses sequencing remains the same for most of the episodes over the past few years. BP has remained relatively stable. Several visit notes over the past few weeks indicate very labile BS and oral hypoglycemic meds changed. Patient has had several rehospitalizations for different reasons but sequencing always remains the same. Diagnoses a. b. c. d. e. f. (M1020) Primary Diagnosis & (M1022) Other Diagnoses (M1020) Primary Diagnosis HTN (M1022) Other Diagnoses COPD DM Obesity Osteoarthritis Hypercholesterol (V-codes are allowed) a (V- or E-codes are allowed) b. (. ) c. (. ) d. (. ) e. (. ) f. (. ) (M1024) Payment Diagnoses (OPTIONAL) (V- or E-codes NOT allowed) a. (V- or E-codes NOT allowed) b. c. d. e. f. (V- or E-codes NOT allowed) a. (V- or E-codes NOT allowed) b. c. d. e. f. POC Field 21 frequency 1 wk 9 Orders & interventions identical on all POC s Field 22 Goals & discharge plans very vague Visit Notes Visit notes remain consistent every week even though there were different symptoms from previous week What are plans for next visit? Are goals being met? What are plans for discharge? Case Conferences Several case conferences noted due to problems with BS yet HTN remains primary diagnosis each episode 3

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12 Thanks for Attending! Feel free to contact us with any questions. Jennifer Warfield, RN, BSN, HCS-D, COS-C Join the PPS Plus Conversation!