• detailing when the ability to access needed items and/or location where the task is performed is included/excluded from ADL/IADL items
• compliance issues related to the use of paper-based standardized assessment tools for meeting CMS process measure criteria
• impact of medical restrictions in specific situations concerning M1242 Frequency Pain Interferes with Activity or Movement, M1830 Bathing and M1850 Transferring
• clarification on staging closed pressure ulcers that re-open
• clarifying guidance related to M2030, Management of Injectable Medications and
• M2250 Plan of Care Synopsis, guidance that changes existing language published in Chapter 3 of the 12/12 OASIS-C Guidance manual. 

• compliance issues with medical record software products that select OASIS responses
  
• compliance with ROC timing when outpatient observation stays occur directly AFTER inpatient admissions
• selecting a response to M1040 when a patient's outcome episode overlaps more than one flu season
• selecting a response for availability of assistance for patients attending adult day care
• changed guidance related to M1300 when both clinical factors and standardized pressure ulcer assessment tools are used
• selecting a response when findings resulting from a multi-factor fall risk assessment and single factor standardized assessment don't match, and
• critical guidance on when/how to report best practice actions provided before the SOC date, and/or before the Comprehensive Assessment is completed
  

Part 1: Sparkle Sparks, PT MPT COS-C 
Senior Associate Consultant, OASIS Answers, Inc.
AHIMA Approved ICD-10-CM Coding Instructor

Last week, CMS confirmed through final rule publication that the implementation date for ICD-10 has officially changed to October 1, 2014.  We all know that codes (currently of the ICD-9 variety) are a required part of our medical documentation.  Many of us participate in one way or another in deciding which codes go where.  But what do they really mean and how careful should we be in selecting them?  When you consider what they’re used for the answer can be stunning.

First and foremost these numbers become part of our patients’ medical records – and they follow them for the rest of their lives.  Remember, “First do no harm.”  This applies to our documentation as well as our clinical interventions.  None of us would intentionally harm our patients yet it seems as though some of us who choose these codes have no idea the damage that we can do when we assign codes erroneously. A classic example is assigning psychiatric codes from the mental disorders chapter based on observations reported on the OASIS or medications that we list on the 485.  The rules that govern the completion of an OASIS are not the same as the coding guidelines. For the rest of Sparkle's article, please click here.

Part 2: Annette Lee, RN MS COS-C HCS-D
Senior Associate Consultant, OASIS Answers, Inc.
AHIMA Approved ICD-10-CM Coding Instructor

Sparkle provided us with a great baseline in why coding is important. I come from a background of working for the Medicare Intermediary- so payment is on my mind.  Is coding still at the core of reimbursement?  Does it really have that much impact?  Short answer: “ Yes”.   So much so, that the OIG addressed coding again in the March 2012 report.  The report noted that in 2008, the records reviewed by the OIG found that home health agencies up-coded (i.e., billed at a level higher than warranted) about 10 percent ($278 million) of claims.  This is a big concern to the government, home health providers, and all of us as taxpayers.  The report went onto say that home health agencies down-coded (i.e., billed at a level lower than warranted) about 10 percent ($184 million) of claims.  Can we as an industry afford to not have appropriate payment, to the tune of $184 million dollars? The short answer, “No!”

Coding has been a part of the case-mix, PPS system since its inception. It has changed (can you say HIPAA?), expanded (Refinement of 2010) and recently contracted (deletion of hypertension codes in 2012) over the years.  We are still all working on getting it right, as CMS provides us with additional guidance. For the rest of Annette's article, please click here. 

Following the continuing saga of the implementation of ICD-10 is like playing a game of “red light, green light.”  Remember that?  Someone yelled “green light” and frantic motion was set in high gear.  Then someone yelled “red light” and you had to freeze, no matter how uncomfortable and hard to maintain your position was.  If you inadvertently moved, you were out of the game.