Download Accurate Coding Strategies for Home Health Therapy

This handout includes slides from parts one and two of the Accurate
Home Health Therapy Coding seminar
Accurate Coding
Strategies for Home
Health Therapy
Lisa Selman-Holman
JD, BSN, RN, CHCE, HCS-D, COS-C
Selman-Holman & Associates, LLC
This handout is intended for exclusive use by authorized viewers who
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Home Care Information Network
Accurate Coding Strategies for Home
Health Therapy – Part One
Accurate Coding Strategies
for Home Health Therapy
Part One
Lisa SelmanSelman-Holman
JD, BSN, RN, CHCE, HCSHCS-D, COSCOS-D
Selman-Holman & Associates, LLC
Outline for Today
¾ Therapy codes
¾ Medical policies from fiscal intermediaries
¾ Therapy practice
2
V57
“V57
is like Heinz 57 steak sauce.
A little is good but too much takes
the taste away.”
away.”
3
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Accurate Coding Strategies for Home
Health Therapy – Part One
The Issues
¾ Overuse of V57.1
z
z
z
z
If therapy is the most intense service (greater
frequency and duration) then it will always be
first. MYTH. We will debunk this myth.
Justifying the use of the casecase-mix diagnosis
first.
Outcome Risk Adjustment
Survey issues
4
Outcome Risk Adjustment
¾ V57.1 20% of all home care diagnoses
¾ Before PPS, top diagnoses
were CHF and
CAD
5
Surveyor Issues
¾ V57.1—
V57.1—Primary diagnosis, but therapy not
there—
there—delay in getting PT started.
¾ Surveyors ask how can therapy be
principle reason for home care if they
arent there yet?
¾ Anxious to get 485 out and therapy
decides that therapy would not be
medically necessary
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Accurate Coding Strategies for Home
Health Therapy – Part One
The Issues
¾ Overuse of 781.2
z
z
Sometimes abnormality of gait is incorrectly
used.
Sometimes the overuse of 781.2 dilutes the
therapy practice.
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The Issues
¾ MO825 includes all therapies
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PPS
¾ MO825 provides 4 points towards the case
mix if marked yes.
¾ (MO825) Therapy need: Does the care
plan of the Medicare payment period for
which this assessment will define a case
mix group indicate a need for therapy
(physical, occupational, or speech
therapy) that meets the threshold for a
Medicare highhigh-therapy case mix group?
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Accurate Coding Strategies for Home
Health Therapy – Part One
Rules on Using V Codes
¾ If care is being provided for a resolving
condition or injury
¾ If continuous care is being provided for a
long term condition
¾ Do not use a V code if treating a current,
acute diagnosis
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Aftercare Therapy V57.x
Use additional code to identify underlying
condition
Primary only
¾ V57.1 Physical therapy (therapeutic and
remedial exercises)
¾ V57.21 Occupational therapy
¾ V57.3 Speech therapy
¾ V57.81 Gait training in the use of
artificial limbs (orthotic
(orthotic training)
¾ V57.89 Multiple training or therapy
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The Primary Only Therapy Codes
¾ As of December 1, 2005 the V57
CATEGORY is primary only.
¾ This does NOT mean that if therapy is
being provided that V57 has to be primary.
¾ What it does mean if that if the patient is
admitted for rehabilitation services then
V57 will be primary.
¾ V57 was never meant to be a “procedure”
procedure”
code
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Accurate Coding Strategies for Home
Health Therapy – Part One
Stats
¾
¾
¾
¾
¾
¾
¾
¾
¾
V57.1-most common V code
V57.1--most
781.2 is the most common payment code when
V57.1 is primary
Muscle weakness
CVA
Difficulty in walking
General weakness
Debility
Parkinsons
Hip fracture
Source: Outcome Concept Systems, Seattle, at the request of Diagnosis
Diagnosis Coding Pro for
Home Health
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Normal Gait
¾ Equilibrium: ability to assume an upright
posture and maintain balance
¾ Locomotion: ability to initiate and
maintain rhythmic stepping
¾ Intact bones, wellwell-functioning joints
¾ Muscle tone
¾ Vision (automatic balance responses to
changes in surface conditions)
¾ Reciprocal innervation
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Abnormal Gait
¾ Ataxic—
Ataxic—unsteady, uncoordinated walk
with a wide base of support and feet
thrown outward
¾ Antalgic—
Antalgic—limp adopted so as to avoid
pain on weight bearing structures
characterized by a very short stance
phase on the injured side.
¾ Apraxic—
Apraxic—loss of ability to carry out
familiar, purposeful movements in the
absence of paralysis or other motor or
sensory impairment
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Accurate Coding Strategies for Home
Health Therapy – Part One
Antalgic Gait
¾ Diabetic foot, OA, joint or limb
deformity, DJD of the cervical spine,
gout, trauma, rheumatoid arthritis
¾ Joint deformity—
deformity—minimal articular
pressure
¾ Muscle weakness—
weakness—feedback
mechanism to protect the joint
structures from excess pressure=disuse
atrophy
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Arthritis and Other Causes
¾ Metatarsal medial cuneiform joint
¾ Rheumatoid—
Rheumatoid—foot deformities
¾ GoutGout-MTP “big toe”
toe”
joint
¾ Diabetic foot
¾ Tendon rupture—
rupture—foot drop
¾ Fracture
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Parkinson’s
¾ Rest tremor
¾ Bradykinesia
¾ Postural instability
¾ Gait: decreased arm swing;
slowness on
turns; forward stoop; small shuffling steps
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Hemiplegia/Hemiparesis
¾ Hemiplegia:
Hemiplegia: total paralysis
z
Rigidity/spasticity
Rigidity/spasticity or flaccid
¾ Hemiparesis:
Hemiparesis: weakness on
one side
¾ Dropfoot:
Dropfoot: may be only indication of a
mildly hemiplegic stroke
¾ Oxygen consumption 64%
higher
¾ 46% slower than normal gait
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Symptoms
¾ If
you know that the symptom is the
result of a specific problem (but not
integral to the problem), code the
problem, then the symptom.
z
Use of 728.87 when the symptom is
the result of a known problem, i.e.
438.21
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*Abnormality Gait—
Gait—781.2
¾ Neurological problems
• CVA, MS, Alzheimer’
Alzheimer’s, Parkinson’
Parkinson’s, ALS,
Myasthenia, Spondylosis,
Spondylosis, etc
¾ Ortho Problems
• Following corrective ortho treatment
¾ Amputations
¾ Includes upper extremity problems
also
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Difficulty Walking—719.7
¾ Used
when a chronic condition is
present and there has been no
repair of joint or bone, i.e., OA
w/o joint replacement
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*Muscle Weakness—728.87
¾ Can
be used for deconditioning
diagnoses as well as atrophy and
general decrease in muscle
strength
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*Muscular Wasting and Atrophy—
Atrophy—
728.2
¾ Describes muscle wasting and disuse
atrophy, NEC—
NEC—this code should not
be used to code a temporary muscle
weakness caused by short
hospitalization. Documentation must
show a measurable decrease in the
size of muscle groups, or a prolonged
period of inactivity.
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Malaise and Fatigue or General
Weakness—
Weakness—780.79
¾Weakness,
lack of strength,
loss of energy, lethargy,
listlessness, may follow viral
infection.
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Debility—799.3
¾ General
and illill-defined term/codeterm/code-frail, weak due to old age, infirm,
feeble
¾ “Repetitive exercises to maintain
gait or maintain strength and
endurance, and assisted walking,
such as that provided in support
for feeble and unstable patients”
patients”
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Accurate Coding Strategies for Home
Health Therapy – Part Two
Accurate Coding Strategies
for Home Health Therapy
Part Two
Lisa SelmanSelman-Holman
JD, BSN, RN, CHCE, HCSHCS-D, COSCOS-D
Selman-Holman & Associates, LLC
Physical Therapy—Not
Just Walking the Patient
Physical Therapy—
Therapy—Not just walking
the patient
Not just for ortho and neuro diagnoses
¾ Deconditioning after a period of inactivity or a
disease exacerbation
¾ Paralysis—
Paralysis—massage, neuromuscular education
¾ Visual disturbances—
disturbances—balance and coordination
¾ Falls (stooped posture—
posture—off balance)
¾ Diabetic neuropathy—
neuropathy—Neuromuscular education
¾ Lymphedema—
Lymphedema—manual therapy
¾ Joint mobilization
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Physical Therapy—
Therapy—Not just walking
the patient
¾ Therapeutic activities
¾ SelfSelf-care management
¾ Wheelchair management training
¾ Varicose veins and ulcers (including PU)
¾ Stress incontinence, other incontinence
¾ Peroneal muscular atrophy
¾ Contractures of joints and ankylosis
¾ Back aches and lumbago
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Physical Therapy—
Therapy—Not just walking
the patient
¾ *714.0 Rheumatoid arthritis
¾ 715.xx DJD, Osteoarthritis
¾ *716.1x Traumatic arthropathy (code also
the late effect code)
¾ *716.9x Arthropathy, NOS
These are chronic diseases of the bone and
joint and so abnormality of gait is NOT
correct.
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Physical Therapy—
Therapy—Not just walking
the patient
¾ V43.6x
(status of joint replacement)
¾ V48.2V48.2-V48.5 problems with head, neck
and trunk
¾ V49.1V49.1-V49.3 mechanical, motor, sensory
¾ V49.6xV49.6x-V49.7x amputation status (may be
primary diagnosis now)
¾ Prosthetics and orthotics
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Physical Therapy—
Therapy—Not just walking
the patient
¾ www.palmettogba.com
Regional Home Health
¾ Click on Provider-Provider--Regional
Intermediary
¾ Click on Medical
Policies (right side of
screen)
¾ Active LCDs
¾ Accept
¾ Scroll
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Debunking the “Most Intense”
Intense” Myth
¾
¾
¾
¾
¾
If multimulti-discipline (including nursing), code
condition being treated first.
If multiple aspects of an acute condition, code the
acute condition first.
If multiple aspects of a care plan for a long term
chronic condition, code the LT chronic condition
first.
If the patient is admitted for rehabilitative
services, code therapy.
If nursing is most intense service and therapy is
there for another reason—
reason—code reason for
nursing, then code reason for therapy
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Multidiscipline-Aftercare Joint
Multidiscipline--Aftercare
Replacement
¾
¾
¾
V54.81V54.81-V54.89 aftercare for orthopedic joint
replacement and other orthopedic aftercare
(use additional code to identify joint)
See V43.6x
You are seeing patient after a joint replacement
to the right knee
MO230 V54.81 Aftercare orthopedic joint
replacement
MO240 V43.65 Knee
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If therapy is only service
¾ MO230 V57.1
¾ MO240 781.2 Abnormality of gait
¾ MO240 V54.81
¾ MO240 V43.64
¾ MO245 781.2
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If nursing and therapy
¾ MO230 V54.81 AC joint replacement
¾ MO240 V43.64 status hip joint
¾ MO240 781.2
abn of gait
¾ MO240 V58.83 monitoring effectiveness of
medications
¾ MO240 V58.61 use of anticoagulants
¾ MO245 781.2
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Multidiscipline
¾ Patient has a fracture of the arm and PT
and OT are ordered at equal visit intensity
and duration. Which code goes first??
¾ V57.89 Multiple therapies
¾ V54.10 Aftercare of the healing traumatic
fracture arm
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Multiple Aspects of an Acute
Condition
¾ MO230 434.91
CVA
Hemiplegia/hemiparesis
¾ MO240 787.2 Dysphagia
¾ MO240 V58.83
¾ MO240 V58.61
¾ MO240 342.xx
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Evolution—Therapy only
Then …
¾ MO230 V57.1
¾ MO240 434.91
¾ MO240 342.90
¾ MO245 434.91
Now…
Now…
¾ MO230 V57.1
¾ MO240 342.xx
¾ MO245 434.91
Another example
MO230 V57.3
MO240 784.5
(dysphasia)
MO245 434.91
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Evolution of the use of acute CVA-CVA-what you may be coding now
¾ MO230 V57.1
PT
V57.21 OT
¾ MO240 342.02 hemiplegia
¾ M0240 V57.3 ST
¾ MO240 784.5 dysphasia
¾ MO245 434.01 CVA
¾ M0240
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**Evolution of the Acute CVA
¾ MO230 V57.89 Multiple therapies
¾ M0240
342.02 hemiplegia
¾ MO240 784.5 dysphasia
¾ MO245 434.01
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Long Term Chronic Conditions
Proximate Diagnosis vs. Underlying Condition
Rule
z
Alzheimer’
Alzheimer’s, Parkinson’
Parkinson’s, MS
¾
What is the real reason you are providing care?
¾
Are you providing care related to one aspect or
symptom of the long term chronic condition?
Are you providing multiple aspects of care
related to that long term chronic condition?
z
¾
(closest reason)
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Long Term Chronic Conditions
¾ If the care plan includes therapy for gait
training, transfers, ADL selfself-management,
neuromuscular reeducation, then the
patient has been admitted for rehab only
¾ M0230 therapy first
¾ M0240 Parkinson’
Parkinson’s
¾ M0245 Parkinson’
Parkinson’s
But what if there is an acute exacerbation?
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Long Term Chronic Conditions
¾
¾
The home health agency will admit a patient with
Parkinson’
Parkinson’s who is having increasing difficulty
with mobility (rigidity and bradykinesia).
bradykinesia). His wife
assists with his ADLs and transfers. PT will
provide transfer training, selfself-care management
and modification, neuromuscular rere-education
and safety teaching. Nursing will provide O&A
and teaching.
MO230 Parkinsons
19
Apply the same concept to an
arthropathy
¾
What we have been coding:
z
z
¾
What Medicare wants us to code:
z
z
¾
V57.1
Rheumatoid arthritis
V57.1
Difficulty in walking
Multiple aspects of care—
care—gait training,
Therapeutic activities, SelfSelf-care management
Wheelchair management training, pain
management
z
Code rheumatoid arthritis first
20
Occupational
Therapy
V57.21
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What does an OT do?
¾ Goal of OT is to prevent, improve or
restore physical and/or cognitive
impairment after disease or injury.
¾ ADL and IADL training
¾ Muscle rere-education
¾ Cognitive training
¾ Perceptual motor training
¾ Fine motor coordination
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What does an OT do?
¾ Adaptive equipment
¾ Transfer training
¾ Functional mobility training
¾ Manual therapy
23
Frequent Questions
¾ Can
V57.21 be in MO230?
alone?
¾ Can OT stand
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OT
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
Incontinence
Swallowing and oral function for feeding
Therapeutic exercises
Splints for maintaining functional position
Neuromuscular rere-education
Massage
Joint mobilization
Myofascial release for restricted joint or soft
tissue motion
SelfSelf-care
Wheelchair management
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OT Codes
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
Ulcerations
Hemiplegia and quadriplegia
Incontinence
Cellulitis involving the upper extremities
Joint problems
Back pain
Muscle weakness
Muscular wasting and disuse
Pathological fractures (not on PT medical policy)
Abnormality of gait
Feeding difficulties 783.3
Fractures of upper limbs
Complication codes (contractures, abnormal scar tissue)
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Speech Language
Pathology
V57.3
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Very Few Case Mix Codes
¾ 781.8 Neurologic
Neglect Syndrome
¾ Deficits resulting from an acute CVA
where the acute CVA can be coded in
MO245
28
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