ICD-9 Codes

Home health, in particular, desire for the field nurse to generate the ICD9 codes so that they can maximize their payments. The more codes the merrier. Of course, the software is never user friendly enough to make this a painless process. If you don't know the correct terminology for the diagnosis code you can spend quite a bit of time searching for things like COPD. Certainly, it makes sense that the intake staff provide the ICD9 associated with the admission, however, it is increasingly left to the field nurse to discover that information. Clearly this makes no sense if the objectives are for the field nurse is to provide care for the patient...it does, however, make sense if the objective for the field nurse is to maximize the payments for the for profit agency. This is a large part of the reason that I no longer work in certified home care...the goals were more about the money and less and less about the patients.

I've asked for a 'cheat sheet'. I've never yet found COPD in the program. When I started at this agency it was all on paper. I love computers, and being able to see other nurse's notes makes it almost worth the extra time. But we are being asked to collect more information, about half of it for insurance purposes, and admissions are tough enough already. Not only is it a task for the nurse, often the patient is just out of the hospital and not in the mood for a thousand questions.

All these computers, yet the patient often comes to us with no information, just a med list.

I'm doing tasks that used to be done in the office, and my pay has not gone up.

Our ICD9 codes are done by 2 office staff trained specifically and only for coding...and thus certified. It's a long process with a huge learning curve.

If coded incorrectly, the agency stands to lose a lot of money, and it is so detailed and intricate, that it's unrealistic to expect all the field nurses to be proficient in coding. I agree with the statement that the field nurses should be providing care and not have to add on the huge burdon of accurate coding.

That said, our agency ALSO provides inservices on anything new in the ICD9 dept. to all our nurses so they have a heads up on how to correctly assess the patients.

It wasn't until I started working on the office and responsible for doing all the 485's from the SOC OASIS, that I fully understood and appreciated that HH is a business as well as a service. We do everything on the up and up, and while I'm prud to say that our prioirity is NOT the almighty $$, it IS important to know how to properly assess in order to code, and thus, properly bill.

But I do prefer the way we do it.. leave the coding to those trained and certified in coding... they DO know what they're doing. Heck, even half the docs offices' ICD9 codes are incorrect when they come througfh.. it's amazing.

Thank you. I think it is pretty shaky to have a nurse putting diagnoses into the record when we don't diagnose. Our office staff used to be better about getting the diagnoses and putting them into the program. Now I'm getting pressure about the coding, which is a whole area I don't know well and don't want to unless I am paid for the office time. It's hard enough to wedge in some actual nursing care on admission, when there's all this information to chase.

I heard that in France they have a card that every patient carries and practitioners can use it to access their medical records. Lost information is one costly problem in the USA.

Thank you. I think it is pretty shaky to have a nurse putting diagnoses into the record when we don't diagnose. Our office staff used to be better about getting the diagnoses and putting them into the program. Now I'm getting pressure about the coding, which is a whole area I don't know well and don't want to unless I am paid for the office time. It's hard enough to wedge in some actual nursing care on admission, when there's all this information to chase.

I heard that in France they have a card that every patient carries and practitioners can use it to access their medical records. Lost information is one costly problem in the USA.

I agree with all the above.

(Field/Road) Nurses really aren't trained in coding and it can cost the HH agency a bundle if not done correctly.. not to mention audits and being kicked into review for denial of payment. As I said, even the referrals we get from the MD offices aren't coded correctly often times. We can't use them if they are wrong, we give all our referrals to our coders to verify and correct if necessary.

That's why I would never do case mgt. Our agency doesn't use that model. We have office nurses for office stuff, and road nurses for the field.

Once the OASIS has been coded and "sent" (billing) I get them and write up the 485's (POC) for each one and then it goes into the hard chart from there.

What I love so much about where I work is that we ALL work together as a team.. both office and road nurses alike. We are truly a team, and we help each other out in all the many facets of the business.

COPD codes: (be aware that there are more, and not all of them are reimburseable. Generally speaking, the higher the specificity the better)

491.0 SIMPLE CHRONIC BRONCHITIS

491.1 MUCOPURULENT CHRONIC BRONCHITIS

491.20 OBSTRUCTIVE CHRONIC BRONCHITIS WITHOUT EXACERBATION

491.21 OBSTRUCTIVE CHRONIC BRONCHITIS WITH (ACUTE) EXACERBATION

491.22 OBSTRUCTIVE CHRONIC BRONCHITIS WITH ACUTE BRONCHITIS

492.8 OTHER EMPHYSEMA (emphysema not otherwise specified, COPD with emphysema, obstructive, panlobular, unilateral, vesicular, etc)

493.20 CHRONIC OBSTRUCTIVE ASTHMA, UNSPECIFIED

493.21 CHRONIC OBSTRUCTIVE ASTHMA, WITH STATUS ASTHMATICUS

493.22 CHRONIC OBSTRUCTIVE ASTHMA, WITH (ACUTE) EXACERBATION

Again, the list goes on and on but these are some of the more common ones. Hope this helps.

thank you, Hmarie. I'll print this out.

Online coding resource: http://icd9cm.chrisendres.com/