ICD 9 codes

[CMCKENZIE.RN]

I am currently in the process of upgrading from AAS NURSING to BSN. As a degree requirement I am required to post a question in my field of employment, homecare. I have often wondered, how many other homecare nurses are faced with the challenge and responsibility of knowing and entering ICD 9 codes on OASIS assessments. Hospitals require a four year degree to code admissions and procedures. How does your homecare agency address this issue? Are your nurses soley responsible for this knowledge?

[KLQ727]

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:)

[Traveler]

I am a field RN in home health with a diploma. I am working toward my BSN. I have to code all of my Oasis in home care.

[renerian, BSN, RN]

I have been in home health most of the time since I started that career in 91. I have always coded my own work. I actually like coding. I wanted to sit for the coding session/exam recently done in our area but could not be spared from work those days. I think you will find many agencies don't view a coder as a necessary expense. I have an ADN, BS, MS-coding not taught in any of those programs.

renerian