Hello everyone, welcome to our Monday Minute. Today I’d like to discuss ICD-10 Coding with you very briefly. One of the things that we need to make sure that everyone is focused on is ensuring that everything that is coded in your home health charts, for sure, is coded based on confirmed documentation that is found from a physician (practitioner) because, of course, your clinicians in Home Health cannot diagnose patients. You must have confirmed diagnoses from physicians (practitioners).
In addition to that, making sure that those codes are to the greatest specificity possible is of vital importance. When it comes to the calculation of your PDGM HIPPS code, henceforth reimbursement, there is a low comorbidity adjustment and a high comorbidity adjustment. The low comorbidity adjustment, inclusive of one single diagnosis included in the secondary diagnoses of your claim, that would go into the calculation of your PDGM HIPPS code, and those codes are very specific codes. Unspecified general codes are typically not going to get that. The high comorbidity adjustment is multiple diagnoses, two or more technically, that fit into a high comorbidity subgroup as defined by the PDGM regulation that are found, again, on your claim that would go into providing that additional case-mix weight, additional reimbursement for your PDGM payment period.
Making sure that you are clear that the diagnoses on the claim itself are the diagnoses that are used to calculate your PDGM payment. So, regardless of whether the diagnoses are on the plan of care or on the OASIS, they have to make it to the claim in order for those to be coded.
I also wanted to point out that effective April 1, 2022, there was an update of diagnosis codes that can be used to code the status of unvaccinated COVID-19 patients, meaning COVID-19 unvaccinated. There’s also a code for patients who are partially vaccinated and there is a code for patients who are not up to date with vaccinations other than COVID-19. All of these codes are in a situation where they could be used or may be used, but not necessarily anything that says they have to be used. Do understand that you are not to use codes that say the patient is unvaccinated if the patient is not eligible for the vaccination, so if they have some health condition or allergy, etc, that prohibits them from being able to participate in COVID vaccinations, then you would not use the unvaccinated code for those patients. Also know that there are additional codes that can be used with the diagnosis code Z28.3 which is the diagnoses we’re talking about with of course, additional fifth and sixth positions. When you use codes from Z28.3. You are asked to use additional codes to define why the patient is not fully vaccinated. Again, not using these codes at all if the patient is not eligible for the COVID-19 vaccine.
One other note that I’m sure you all know about by this time, the Public Health Emergency was extended for an additional 90 days. So it is currently active until mid-July. Will they renew it at that point? No one has any idea, but at this point, it is still considered an active Public Health Emergency through mid-July.Keeping in mind that in conjunction with that for home health and hospice purposes, the COVID-19 1135 waivers are still in place and are still applicable to the care that you’re providing to the patient. As we discussed a few weeks ago, you do need to be preparing your agency so that if the Public Health Emergency does officially end in July, as far as the federal government is concerned, those waivers will go away andanything that you have been participating in, as far as those waivers would are concerned, would be eliminated. So you need to make sure you are moving toward preparation for that time.
We want to thank you all for participating today. If you have any additional questions, please don’t hesitate to let us know. We will provide a link in the minute today to the new updated diagnosis codes that I’ve mentioned.
We want to thank you all as this Public Health Emergency continues for being on the front lines and taking care of patients as you have been so diligent to do so. We are hot and heavy traveling this summer, seeing many of you, I hope, in your State and National Home Care & Hospice Association conferences. Thank you very much and have a fabulous week.