Proper home health coding for Medicare OASIS
The process of selecting correct diagnosis codes for a OASIS Start of Care, Re-Certification or Resumption of Care is very straightforward and uncomplicated.
Include only problems (diagnoses) for which there is a change in medications or skilled treatments.
If a patient is to receive home health services paid for by Medicare,
- the services must be ordered by a licensed physician
- the patient must have an unstable condition
- there are new or changed treatments/medications for the unstable condition
- the patient must be homebound.
The diagnosis codes to be documented in the OASIS assessment under M1021/3 are reflective of the unstable condition(s) ONLY. If a condition has no medical or skilled treatment changes prdered by the physician the diagnosis should NOT be included in the list. A condition requiring a new or changed medication, therapy and/or a new/changed skilled nursing treatment is appropriate for inclusion on M1021/3.
It can be tempting…
It can be tempting to include diagnoses that are stable, especially stable casemix diagnoses that because they yield the HHA potentially more reimbursement. This practice of using stable casemix diagnoses is called up-coding and is an unacceptable method of coding.
For example…
For example, a patient is admitted to an HHA with a history of CHF, hypertension, Diabetes Mellitus, chronic pain, exacerbation in psoriasis. The only change to the medical careplan is a new medication for psoriasis. Although the patient has multiple health problems they are all stable except for psoriasis. Since that is the case, only psoriasis should be listed on the diagnosis list. Conditions requiring no change to the careplan are considered “stable’ and should not be on the diagnosis list.
For supporting documentation please refer to CMS’s guide to home health diagnosis coding go https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/downloads/HHQIAttachmentD.pdf
For more information on Medicare's Home Health Care Quality Indicators click here.
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