This is a hotly debated item in our industry. There are a couple of list serves run by the Home Health Line group and this discussion is a constant factor. You may want to check these out if you need more data than you might acquire here. (PM me if you need info)
I am an RN BSN PHN with over 27 years experience in home health. Currently, my job is QI coordinator for a for-profit HHA. The major component of my job is to review the OASIS data and code it with ICD9 codes. My experience is and has been (in this company at least) that our field staff can barely tell you what their primary focus is with the patient, much less code it correctly. Whatever the intake staff put on the referral as a diagnosis, is what comes back to me on the OASIS. In a couple of instances, the LVN intake person misunderstood what she heard and wrote down a phoenetically spelled diagnosis. It came back to me spelled exactly that way on the OASIS. (And in one instance was not the diagnosis at all.) If she put down supercalfragalisticexpialidocious it would be regurgitated by some staff. Some actually do have a clue, but still can't code it.
It amazes me that some agencies do find sufficient field staff to provide quality care, and to code accurately as well. And I'm in a large metropolitan area (Los Angeles)!
We don't invest a lot of time (minimal actually) in mandatory meetings, and staff education. Other places I have worked under PPS have done a lot of staff development, and it makes a big difference. However, they had QI dept. code the OASIS as well.
In all fairness, however, it's a very difficult task to code. If I were a field nurse again, I wouldn't want to be coding my paperwork. I would feel obliged to provide quality care to my patient, and resentful of the time taken away to code. I feel strongly that is as it should be. Field staff should be field staff and not coders, and billers, and insurance verifiers.
Hope this helps.
Kathy Quan RN BSN PHN
Would you like to comment?
ICD9 codes
