help with coding
Please help. Scenario: 68 yr old male, prostate CA getting radiation, Gerd- 10 lb weight loss in 4 months, hx duodenal ulcers-epigastric pain-- constipation, muscle weakness and new benign nodules on right and left lung with shortness of breath. Any suggestions for payment codes. We don't seem to be able to get points for any of this, yet the man is in need of home health. Thanks in advance.
Joann
Joann P. Bush RN, BAAdministrator/Director of NursingBetter Home Care, LLC.1046 Bustleton PikeFeasterville, PA. 19053www.betterhomecare.org phone: 267-988-8978 ext # 1006direct line: 267-751-4002fax: 267-988-8979 This message and any attachments are intended solely for the addressee(s) named above and may contain confidential and legally privileged information. Any unauthorized use, disclosure or copying in any manner is strictly prohibited. If you have received this message in error, please notify the Account Representative identified above and then delete this message and any attachments from your system.
Joann
Joann P. Bush RN, BAAdministrator/Director of NursingBetter Home Care, LLC.1046 Bustleton PikeFeasterville, PA. 19053www.betterhomecare.org phone: 267-988-8978 ext # 1006direct line: 267-751-4002fax: 267-988-8979 This message and any attachments are intended solely for the addressee(s) named above and may contain confidential and legally privileged information. Any unauthorized use, disclosure or copying in any manner is strictly prohibited. If you have received this message in error, please notify the Account Representative identified above and then delete this message and any attachments from your system.
-------- Original Message --------
Subject: homecarecoding-l digest: October 05, 2016
From: "HomeCareCoding-L digest" <homecarecoding-l@list.myhomehealth.com>
Date: Thu, October 06, 2016 1:00 am
To: "homecarecoding-l digest recipients"
<homecarecoding-l@list.myhomehealth.com>
HOMECARECODING-L Digest for Wednesday, October 05, 2016.
1. Re: Chronic Systolic Heart Failure
2. re: COS-C Exam
3. New Diabetes assumption
4. HCS-D Exam. Can you use the AAPC ICD-10-CM Expert Coding Book??
5. RE: HCS-D Exam. Can you use the AAPC ICD-10-CM Expert Coding Book??
6. RE: HCS-D Exam. Can you use the AAPC ICD-10-CM Expert Coding Book??
7. RE: HCS-D Exam. Can you use the AAPC ICD-10-CM Expert Coding Book??
8. Vascular Dementia
9. RE: Vascular Dementia
10. re: New Diabetes assumption
11. RE: Vascular Dementia
12. knee buckling
13. RE: Diabetes with PAD
14. hh ordered after pacemaker insertion
15. Open fracture
16. re: consistent with
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Subject: Re: Chronic Systolic Heart Failure
From: Barbara Sheeler <barbara.sheeler@gmail.com>
Date: Wed, 5 Oct 2016 06:47:03 -0500
X-Message-Number: 1
I would not code the weakness, as it would be integral to the chf.
i11.0
i50.32
e11.9
f01.50
i25.10
z95.810
If you look at your guidance...at i11.0-----
Hypertension with heart conditions classified to I50.- or I51.4-I51.9, are
assigned to a code from category I11, Hypertensive heart disease. Use an
additional code from category I50, Heart failure, to identify the type of
heart failure in those patients with heart failure.
Use Additional Code
code to identify:
exposure to environmental tobacco smoke (Z77.22)
history of tobacco dependence (Z87.891)
occupational exposure to environmental tobacco smoke (Z57.31)
tobacco dependence (F17.-)
tobacco use (Z72.0)
Barbara Sheeler, LVN, HCS-D, HCS-O
Quality Assurance Review Coder
On Mon, Oct 3, 2016 at 10:29 PM, Dorothy Schulte <dorothy.schulte@att.net>
wrote:
> Thanks. Would you code the weakness or is that integral to the CHF?
> ---
> This list is a co-sponsored service of the Board of Medical Specialty
> Coding & Compliance (http://www.medicalspecialtycoding.com) and
> DecisionHealth (http://www.decisionhealth.com), publisher of Diagnosis
> Coding Pro for Home Health. To access the web interface, go to
> http://www.decisionhealth.com/homecarecoding-l and enter your e-mail
> address. Click on the My Account tab and then the Advanced tab to set or
> change your password. Click on the Essentials tab and Membership Type to
> set the way you want to access list messages.
>
----------------------------------------------------------------------
Subject: re: COS-C Exam
From: "Deb Bessette-Gaudette" <dbessette@daykimball.org>
Date: Wed, 05 Oct 2016 08:06:58 -0400
X-Message-Number: 2
I have taken that exam twice & both times I took the 2 day Blueprint course just prior to the exam. I used the book that was provided for the course. If you have the option to take the class I recommend it.
Deb Bessette-Gaudette RN,BCHH-C,HCS-D,COS-C
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Subject: New Diabetes assumption
From: "Janine Candela" <jcandela@masonicare.org>
Date: Wed, 05 Oct 2016 09:30:08 -0400
X-Message-Number: 3
What is everybody doing for coding Diabetic assumptions recently approved by Coding Clinic? I know as of 10.01.16 coding rules have changed regarding Diabetes. If we have any existing cases that have Diabetes with Gangrene or Osteo. etc, but DOS is prior to 10.01.16 Should we change coding at Recert time or leave as is?
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Subject: HCS-D Exam. Can you use the AAPC ICD-10-CM Expert Coding Book??
From: "Katherine Moss" <Kbeau78@gmail.com>
Date: Wed, 05 Oct 2016 10:38:00 -0400
X-Message-Number: 4
I bought this coding book this year because it does give you more explanations that I otherwise would be going on the internet to seek. When I take the test is this book allowed or am I in a pickle?? Thanks!
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Subject: RE: HCS-D Exam. Can you use the AAPC ICD-10-CM Expert Coding Book??
From: Carolyn Brunk <CBrunk@totalhh.com>
Date: Wed, 5 Oct 2016 14:53:44 +0000
X-Message-Number: 5
Can double check the web site but when I tested that was the only resource you could use. I tested last year. no free papers, no post it notes but you can write some notes in margins.
Priscilla Brunk RN, HCS-D
Corporate Coder
Cell: 772-284-1185
Fax: 954-962-2667
-----Original Message-----
From: Katherine Moss [mailto:Kbeau78@gmail.com]
Sent: Wednesday, October 5, 2016 10:38 AM
To: HomeCareCoding-L
Subject: [homecarecoding-l] HCS-D Exam. Can you use the AAPC ICD-10-CM Expert Coding Book??
I bought this coding book this year because it does give you more explanations that I otherwise would be going on the internet to seek. When I take the test is this book allowed or am I in a pickle?? Thanks!
---
This list is a co-sponsored service of the Board of Medical Specialty Coding & Compliance (http://www.medicalspecialtycoding.com) and DecisionHealth (http://www.decisionhealth.com), publisher of Diagnosis Coding Pro for Home Health. To access the web interface, go to http://www.decisionhealth.com/homecarecoding-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages.
----------------------------------------------------------------------
Subject: RE: HCS-D Exam. Can you use the AAPC ICD-10-CM Expert Coding Book??
From: Trish Twombly <TTwombly@decisionhealth.com>
Date: Wed, 5 Oct 2016 14:59:28 +0000
X-Message-Number: 6
From the AHCC/BMSC website: https://ahcc.decisionhealth.com/credentialed-results.aspx
Allowed materials
HCS-D and HCS-H Exam:
You may take only ONE of the following manuals into the testing room:
Complete Home Health ICD-10-CM Diagnosis Coding Manual, 2017. Available for purchase in the DecisionHealth online store.
Complete Home Health ICD-10-CM Diagnosis Coding Manual, 2016
Any other vendorâs ICD-10 coding manual (2016 or 2017 Edition)
In addition to the above referenced coding manual, for the HCS-D exam, you may take the FY2017 official guidelines provided here into the testing room. Please note, only the watermarked guidelines provided through this link will be allowed into the testing room as an additional resource.
*Note, BMSC recommends a current code year, 2017, coding manual be used when taking the HCS-D or HCS-H exam.
Electronic code look-up systems are NOT allowed in the testing room. A hard copy coding manual is the only allowed resource.
The hard copy coding manual may have tabular section dividers (A through Z) that are affixed. You may have annotations written on the coding manual pages including the notes pages at the back of the manual but they must be free of any notes containing coding rules and guidelines from other reference materials (for example, Coding Clinic, Home Health ICD-10-CM Coding Answers, and similar materials).
NOT ALLOWED:
Alphabetical section dividers
Post-It notes
Loose papers or any other papers attached by any means
The testing center staff or exam proctor reserves the right to deny code books that contain excessive writing and information that may give the candidate an unfair advantage.
-----Original Message-----
From: Carolyn Brunk [mailto:CBrunk@totalhh.com]
Sent: Wednesday, October 05, 2016 10:54 AM
To: HomeCareCoding-L
Subject: RE: [homecarecoding-l] HCS-D Exam. Can you use the AAPC ICD-10-CM Expert Coding Book??
Can double check the web site but when I tested that was the only resource you could use. I tested last year. no free papers, no post it notes but you can write some notes in margins.
Priscilla Brunk RN, HCS-D
Corporate Coder
Cell: 772-284-1185
Fax: 954-962-2667
-----Original Message-----
From: Katherine Moss [mailto:Kbeau78@gmail.com]
Sent: Wednesday, October 5, 2016 10:38 AM
To: HomeCareCoding-L
Subject: [homecarecoding-l] HCS-D Exam. Can you use the AAPC ICD-10-CM Expert Coding Book??
I bought this coding book this year because it does give you more explanations that I otherwise would be going on the internet to seek. When I take the test is this book allowed or am I in a pickle?? Thanks!
---
This list is a co-sponsored service of the Board of Medical Specialty Coding & Compliance (http://www.medicalspecialtycoding.com) and DecisionHealth (http://www.decisionhealth.com), publisher of Diagnosis Coding Pro for Home Health. To access the web interface, go to http://www.decisionhealth.com/homecarecoding-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages.
---
This list is a co-sponsored service of the Board of Medical Specialty Coding & Compliance (http://www.medicalspecialtycoding.com) and DecisionHealth (http://www.decisionhealth.com), publisher of Diagnosis Coding Pro for Home Health. To access the web interface, go to http://www.decisionhealth.com/homecarecoding-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages.
----------------------------------------------------------------------
Subject: RE: HCS-D Exam. Can you use the AAPC ICD-10-CM Expert Coding Book??
From: "Katherine Moss" <Kbeau78@gmail.com>
Date: Wed, 05 Oct 2016 11:18:20 -0400
X-Message-Number: 7
Thanks! I follow several groups on Facebook and I thought I read where you could not use this one. Now I feel better!. Thanks again!
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Subject: Vascular Dementia
From: "LOUELLA GOCO" <LGOCO@EXPEDIENTHHC.COM>
Date: Wed, 05 Oct 2016 11:21:20 -0400
X-Message-Number: 8
There are new, more specific codes for Cognitive Deficits following Cerebral Infarction.
If ALL that the MD gives is "Vascular Dementia d/t CVA", would you agree that this would be acceptable coding:
I69.318 Other s/s involving cognitive functions following cerebral infarction
F01.50 Vascular dmentia without behavioral disturbance
Thank you in advance for your input! :-)
----------------------------------------------------------------------
Subject: RE: Vascular Dementia
From: Carolyn Brunk <CBrunk@totalhh.com>
Date: Wed, 5 Oct 2016 15:28:30 +0000
X-Message-Number: 9
Sounds right to me.
Priscilla Brunk RN, HCS-D
Corporate Coder
Cell: 772-284-1185
Fax: 954-962-2667
-----Original Message-----
From: LOUELLA GOCO [mailto:LGOCO@EXPEDIENTHHC.COM]
Sent: Wednesday, October 5, 2016 11:21 AM
To: HomeCareCoding-L
Subject: [homecarecoding-l] Vascular Dementia
There are new, more specific codes for Cognitive Deficits following Cerebral Infarction.
If ALL that the MD gives is "Vascular Dementia d/t CVA", would you agree that this would be acceptable coding:
I69.318 Other s/s involving cognitive functions following cerebral infarction
F01.50 Vascular dmentia without behavioral disturbance
Thank you in advance for your input! :-)
---
This list is a co-sponsored service of the Board of Medical Specialty Coding & Compliance (http://www.medicalspecialtycoding.com) and DecisionHealth (http://www.decisionhealth.com), publisher of Diagnosis Coding Pro for Home Health. To access the web interface, go to http://www.decisionhealth.com/homecarecoding-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages.
----------------------------------------------------------------------
Subject: re: New Diabetes assumption
From: "LOUELLA GOCO" <LGOCO@EXPEDIENTHHC.COM>
Date: Wed, 05 Oct 2016 11:28:08 -0400
X-Message-Number: 10
Hi!
My opinion is that it should be fine either way - as long as the etiology has not been identified.
All the best!
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Subject: RE: Vascular Dementia
From: "LOUELLA GOCO" <LGOCO@EXPEDIENTHHC.COM>
Date: Wed, 05 Oct 2016 11:33:49 -0400
X-Message-Number: 11
Thank you, Priscilla!
All the best!
Louella
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Subject: knee buckling
From: "Jessica Patlyek" <jessica.patlyek@healthcarefirst.com>
Date: Wed, 05 Oct 2016 12:36:51 -0400
X-Message-Number: 12
Would I look under instability, joint, knee for this? M25.36_
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Subject: RE: Diabetes with PAD
From: Reyhan Rzayeva <Reyhan@NYSHH.com>
Date: Wed, 5 Oct 2016 21:07:08 +0000
X-Message-Number: 13
Need some help with coding. If pt had subdural hematoma as a result of fall (S06.5X0D), but later underwent burr hole drainage, craniotomy, would it be considered encounter for specified surgical aftercare (Z48.89)?
Thank you!
From: Kayla Ford [mailto:kaylee1026@live.com]
Sent: Thursday, August 11, 2016 9:51 AM
To: HomeCareCoding-L
Subject: RE: [homecarecoding-l] Diabetes with PAD
Thank you!
Sent from my Verizon Wireless 4G LTE smartphone
-------- Original message --------
From: Carolyn Brunk <CBrunk@totalhh.com><mailto:CBrunk@totalhh.com>>
Date: 08/11/2016 09:44 (GMT-05:00)
To: HomeCareCoding-L <homecarecoding-l@list.myhomehealth.com><mailto:homecarecoding-l@list.myhomehealth.com>>
Subject: RE: [homecarecoding-l] Diabetes with PAD
YES
Priscilla Brunk RN, HCS-D
Corporate Coder
Cell: 772-284-1185
Fax: 954-962-2667
-----Original Message-----
From: K. Ford [mailto:Kaylee1026@live.com]
Sent: Thursday, August 11, 2016 10:39 AM
To: HomeCareCoding-L
Subject: [homecarecoding-l] Diabetes with PAD
Pt has confirmed DM, confirmed severe PAD and confirmed left lower arterial ulcer. No documentation on relationship between DM and ulcer or DM and PAD. Under the new guidance, would you code E11.51, E11.622 and follow with the L97 code?
---
This list is a co-sponsored service of the Board of Medical Specialty Coding & Compliance (http://www.medicalspecialtycoding.com) and DecisionHealth (http://www.decisionhealth.com), publisher of Diagnosis Coding Pro for Home Health. To access the web interface, go to http://www.decisionhealth.com/homecarecoding-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages.
---
This list is a co-sponsored service of the Board of Medical Specialty Coding & Compliance (http://www.medicalspecialtycoding.com) and DecisionHealth (http://www.decisionhealth.com), publisher of Diagnosis Coding Pro for Home Health. To access the web interface, go to http://www.decisionhealth.com/homecarecoding-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages.
---
This list is a co-sponsored service of the Board of Medical Specialty Coding & Compliance (http://www.medicalspecialtycoding.com) and DecisionHealth (http://www.decisionhealth.com), publisher of Diagnosis Coding Pro for Home Health. To access the web interface, go to http://www.decisionhealth.com/homecarecoding-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages.
----------------------------------------------------------------------
Subject: hh ordered after pacemaker insertion
From: "Deborah Falen" <debbie.falen@echospital.org>
Date: Wed, 05 Oct 2016 17:05:29 -0400
X-Message-Number: 14
patient was seen in ER then admitted to OBV for a sycopal episode and noted to have periods of asystole and complete heart block. Patient was taken to OR and had a permanent pacemaker implanted.
Physician noted Sick Sinus syndrome with atrioventricular nodal disease with asytole and complete heart block causing the syncope.
2nd diagnosis: Gerd, moderate aortic regurgitaion, mild aortic stenosis.
HH was ordered to go in to monitor incision for s/s of infection and medication teaching.
Would this be a surgical aftercare of the circulatory system?
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Subject: Open fracture
From: "Jessica Patlyek" <Jessica.Patlyek@healthcarefirst.com>
Date: Wed, 05 Oct 2016 17:51:48 -0400
X-Message-Number: 15
What do I look under to find these? My patient has an open right tib fracture. All I'm finding is S82.201D. How do I specify it's open?
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Subject: re: consistent with
From: "Kristin Rodriguez" <consultingbykristin@cox.net>
Date: Wed, 05 Oct 2016 23:40:56 -0400
X-Message-Number: 16
No. Consistent with implies a working diagnosis, similar to a probable, possible, rule out. Medicare defines this as theoretical. There used to be a Medicare article about use of consistent with but I haven't seen in a very long time.
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Comments
From what you've put, nothing screams to debilitated to go to a doctor for care and treatment.
That being said, it may be very obvious to those of you in home health, but if that's the picture being painted to the insurance carrier, I can see why they may question the necessity.
Is the patient debilitated as opposed to just muscle weakness? Is the patient suffering from neoplastic pain? is the patient dealing with failure to thrive or cachexia?
What are the denials telling you?
Maybe the ordering physician needs to provide more in depth diagnoses for you?