The role of ICD-10 coding in home health continues to be a area of audit susceptibility for many home health agencies. Completion of code assignment, although not the responsibility of the clinician, many times will fall to the individual responsible for OASIS completion. The use of code “cheat sheets,” electronic “scrubbers” and software systems are geared to reduce the demand for human involvement in the determination of episode primary and secondary (co-morbidity) coding in the home health industry. However, the ability to ensure ICD-10 code selections truly reflect the foci and nuances of care as outlined on the patient-centered Plan of Care (PoC), along with most current coding guidance, demands the involvement of human oversight.
Failure to assure accurate ICD-10 code assignment can lead to improper claim submission (and subsequent claim rejection), as well as significantly impact episodic payment rates through calculation of the “C” (clinical) contribution of the Home Health Related Groupings (HHRG) score, and even open an agency to external audit scrutiny into billing practices. Improper episode payments linked to ICD-10 coding errors can lead to additional documentation requests (ADRs) and denials from third party payers.
There are many ways to become educated in accurate ICD-10 coding competent and credentialed, however the process can be both time-consuming and financially burdensome to both the individual and the home health agency. Assuring ICD-10 coding accuracy frequently falls to the Quality department of an agency, that may or may be versed in the nuances of coding specific to home health, or credentialed as competent.
Kornetti & Krafft Health Care Solutions believes that ICD-10 coding accuracy can be achieved through a combination of intake and frontline clinician education to ensure the necessary documentation is present to facilitate code assignment to conditions, diseases, and illnesses that best reflect the care plan for each individual patient episode of care, and in-depth training of review and quality staff in ICD-10 code selection and ordering. Our training products and tools are intended to enhance the fluency of the patient-centered interdisciplinary episode of care from intake, through ICD-10 coding and clinician documentation to assure compliance in agency operations.
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