COPD as primary Dx

Brenda

We have been having an ongoing discussion regarding the use of COPD as primary dx. What are your opinions? I can't find any Coding instruction in the coding manual regarding this topic. I have stated the importance of coding what specifically the COPD is, but in this discussion it is if COPD without an exacerbation may be primary. I know that COPD is a chronic illness and that it may be questioned as to why the patient is be cared for by home health. Other than that, is there anything that states you can't assign it as primary?

Thanks:)

Brenda Hoss
Coder

SusanWinokur

The question is, what is driving the need for skilled homecare? Does the patient have a new diagnosis, or need ongoing monitoring and teaching re the use of medications or treatments? Was there a change, such as now requiring oxygen, or noncompliance with treatment? Is this the diagnosis responsible for the patient's recent decline or need for PT/OT for strengthening, energy conservation, or safety concerns around the house? There are many potential reasons that a chronic disease may qualify as the primary diagnosis for homecare, even when there is no current or recent exacerbation.

Susan Winokur, HCS-D, BCHH-C | Family Healthcare Services
Part of OptumCare
Senior Medical Coder, Home Health and Hospice
8655 South Eastern Avenue, Las Vegas, NV 89123 USA
T +1 702-838-0644
Susan.Winokur@optum.com
smalv.com

kyleintegrityhh@gmail.com

A chronic illness may still be a primary diagnosis. It is all in how the nurse documents the primary reason for HH. Just because there is no "exacerbation" if there is a recent med change or 02 is added or PT or OT is specifically working on issues r/t the COPD "endurance management" you could put the standard COPD as primary as long as it is justified in the POC and nurses documentation.

Kyle Johnson, RN, HCS-D, COS-C, BCHH-C, HCS-H
Owner, Home Health Coding Solutions