Section O: Special Treatments Can Increase the Patient's Case Mix and Your Reimbursement.
If the patient has any of the following conditions make sure coding and medications support the answers to Section O.
1. If the patient is currently receiving cancer treatment...
MAKE SURE...
- If the home health clinician is administering the oral, IV, IM, or SC chemotherapy medication, include "Encounter for antineoplastic chemotherapy (Z51.11)" (PDGM = 'D') in the coding profile (M1021/M1023) since it may increase the case mix.
- M1021 or M1023 includes the patient's cancer diagnosis - an ICD beginning with 'C' or 'D'
- The cancer medication(s) are included in the medication profile.
2. If the patient is receiving oxygen therapy (O2)...
MAKE SURE...
- M1021 and/or M1023 includes the respiratory and/or cardiac diagnosis - an ICD beginning with 'I' or 'J'. Most cardiac and respiratory diagnoses are case mix PDGMs and/or manifestations that will increase the the overall case mix.
- Although not a PDGM or manifestation, the diagnosis "Dependence on supplemental oxygen (Z99.81)" can be included in M1023.
- Oxygen therapy is included in the medication profile
3. If the patient requires suctioning...
MAKE SURE...
- M1021 or M1023 includes the neurological, respiratory, ventilator and/or tracheostomy diagnosis that prompts the need for suctioning. Ventilator and Tracheostomy are both PDGMs. Related neurological and respiratory diagnoses are likely case mix PDGMs and/or manifestations that will increase the overall case mix.
4. If the patient has a tracheostomy...
MAKE SURE...
- M1021 or M1023 includes the PDGM Tracheostomy diagnosis. 'Suctioning' (see above) should also be checked. Any of the following are case mix PDGMs:
J95.01 Hemorrhage from tracheostomy stoma (J95.01)
J95.02 Infection of tracheostomy stoma (J95.02)
J95.03 Malfunction of tracheostomy stoma (J95.03)
J95.04 Tracheo-esophageal fistula following tracheostomy (J95.04)
J95.09 Other tracheostomy complication (J95.09)
Z43.0 Encounter for attention to tracheostomy (Z43.0)
5. If the patient requires an Invasive Mechanical Ventilator...
MAKE SURE...
- M1021 or M1023 includes the PDGM Ventilator diagnosis. 'Suctioning' (see above) should also be checked. Any of the following are case mix PDGMs.
Other complication of respirator [ventilator] (J95.859)
Dependence on respirator [ventilator] status (Z99.11)
6. If the patient requires a BiPAP or CPAP machine for breathing...
MAKE SURE...
- M1021 or M1023 includes the sleep apnea, COPD, or other respiratory diagnosis requiring the intervention. Any of the following are case mix PDGMs.
Sleep apnea, unspecified (G47.30)
Primary central sleep apnea (G47.31)
Obstructive sleep apnea (adult) (pediatric) (G47.33)
Other sleep apnea (G47.39)
7. If the patient requires intravenous (IV) vasoactive, antibiotic, anticoagulant or other IV medication during the home health admission...
MAKE SURE...
- M1021 or M1023 includes the cardiac, infection or other diagnosis requiring the medication(s). The diagnosis "Encounter for adjustment and management of VAD (Z45.2)" - although not a PDGM or manifestation - should also be included. VAD = 'vascular access device'.
- Include IV Access selection
8. If the patient requires a transfusion for red blood cell, platelet, plasma, white blood cell and/or whole blood during the home health admission...
MAKE SURE...
- M1021 or M1023 includes the cardiac, infection or other diagnosis requiring the transfusion(s). The diagnosis "Encounter for adjustment and management of VAD (Z45.2)" - although not a PDGM or manifestation - should also be included. VAD = 'vascular access device'.
- Include IV Access selection
9. If the patient requires kidney dialysis during the home health admission...
MAKE SURE...
- M1021 or M1023 includes the kidney (chronic or acute) failure diagnosis requiring the dialysis(s):
Acute kidney failure with tubular necrosis (N17.0)
Acute kidney failure with acute cortical necrosis (N17.1)
Acute kidney failure with medullary necrosis (N17.2)
Other acute kidney failure (N17.8)
Acute kidney failure, unspecified (N17.9)
Postprocedural (acute) (chronic) kidney failure (N99.0)
Chronic kidney disease, stage 1 (N18.1)
Chronic kidney disease, stage 2 (mild) (N18.2)
Chronic kidney disease, stage 3 unspecified (N18.30)
Chronic kidney disease, stage 3a (N18.31)
Chronic kidney disease, stage 3b (N18.32)
Chronic kidney disease, stage 4 (severe) (N18.4)
- Dependence on renal dialysis (Z99.2)" - although not a PDGM or manifestation - should also be included.
- Include IV Access selection
10. If the patient requires any IV medication or kidney dialysis during the home health admission...
MAKE SURE...
- the correct IV access is documented
- The diagnosis "Encounter for adjustment and management of VAD (Z45.2)" - although not a PDGM or manifestation - is included. VAD = 'vascular access device'.
Rule #3 for Preventing Re-Hospitalization? Retire the Answering Machine.
Teach the Patient/Caregiver How to Take a Blood Pressure
OASIS-E O0110A: Are You Careplanning for Chemotherapy?
