Special Instructions for ICD-10-CM Coding on Home Health (HH) Claims
February 25, 2014 11:13 AM
CMS issued special instructions for the International Classification of Diseases, Clinical Modification 10th Edition (ICD-10-CM) Coding on home health claims that span October 1, 2014. In an earlier transmittal CMS stated it would “allow HHAs to use the payment group code derived from ICD-9-CM codes on claims which span 10/1, but require those claims to be submitted using ICD-10-CM codes.”
Initial Episodes that begin prior to October 1, 2014
In the case of home health episodes, the assessment completion date (M0090 date) determines whether the HH Grouper software that determines the payment group for the episode will apply ICD-9-CM or ICD-10-CM codes to the episode. In the case where the episode start of care date is before October 1, 2014 and the M0090 date is also before October 1, 2014, ICD-9-CM codes will be used on the OASIS and to determine the payment group code (the Health Insurance Prospective Payment System (HIPPS) code).
Episodes Starting Before October 1, 2014 with OASIS Completion Dates in October 2014
There may be cases where the episode start of care date is before October 1, 2014 and, due to the 5 day completion window, the M0090 date is in October 2014. For example, an initial episode with a start of care date of September 28, 2014 could have an M0090 date of October 2, 2014. In these cases, ICD-10-CM codes will be used on the OASIS and to determine the HIPPS code.
The RAP for this example would have “From” and “Through” dates of September 28, 2014. As a result, these RAPs would need to report ICD-9-CM diagnosis codes even though ICD-10-CM codes were used on the OASIS assessment.
Requests for Anticipated Payment (RAPs)
On RAP, the “From” and “Through” dates are the same. So if the episode begins in September 2014, the “From” and “Through” dates on the RAP would report the same date in September. These RAPs would report ICD-9-CM diagnosis codes using codes matching the OASIS assessment.
If the home health episode spans into October 2014, the corresponding final claim for the episode will be required to report ICD-10-CM codes. HH claims cannot be split into periods before and after October 1, 2014, so these claims will have claim “Through” dates of October 1, 2014 or later. The HIPPS code on the final claim must match the HIPPS code that was reported on the RAP. The HIPPS code on the RAP was based on the ICD-9-CM codes matching the OASIS assessment.
The article also provides instruction for ICD-10-CM coding on HH claims that Span October 1, 2014 for Recertification and Resumption of Care OASIS assessment.
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