advice from cahaba, my agency's medicare intermediary
from medicarea newsline 1/1/05, vol 12, no 4, pgs. 66 -70
https://www.cahabagba.com/part_a/education_and_outreach/newsletter/0105.pdf
link updated 2/21/07
4/08--link no longer available
reminder and updates to “helpful tips on completion of the oasis”
the article helpful tips on completion of the oasis was published in the october 1, 2003, medicare a newsline. our medical review department continues to deny services based on inappropriate coding of the weighted outcome & assessment information set (oasis) m0 items. therefore, as a reminder, the tips are being repeated, and have been updated as necessary. these tips address reimbursement issuesrelated to the 23 specific oasis m0 locators used for payment of claims under the home health prospective payment system (hh pps). please share the following information with your staff.
general
tip 1 - if m0 locators are not easily identified in your agency’s comprehensive assessment, you may highlight or bold these areas in the medical record documentation, so they are not missed during medical review.
tip 2 – when you receive an additional development request (adr) for medical records, ensure the correct oasis is sent for the health insurance prospective payment system (hipps) code(s)billed on the claim that received the adr request. if a significant change in condition (scic) is billed, a corresponding oasis should be sent for each of the hipps codes billed.
m0175 inpatient discharge
tip 1 – obtain this information from the referral source, the hospital discharge planner, or the physician. also verify the information by accessing the eligibility screen elga, as described in the june 1, 2004, medicare a newsline article medicare resources for researching inpatientdischarges within 14 days of a home health admission. this can be found on our web site at:
http://www.iamedicare.com/provider/newsroom/newslines/newslines.htm
tip 2 – when counting the 14-day period for discharge from a facility, count your day of home health admission or recertification as day 0, the previous day as day 1, etc.
tip 3 – remember that more than one response may be checked for this m0 locator. if a patient was discharged from both a hospital and a skilled nursing facility (snf) in the past 14 days, responses 1 and 3 should both be checked for m0175.
m0230 primary diagnosis
tip 1 – the icd-9-cm code and narrative used as the primary diagnosis on the plan of care should match the primary diagnosis on the oasis.
tip 2 – the primary diagnosis is the main reason you are seeing the patient in their home and the diagnosis that requires the most intensive skilled services. if the patient is a diabetic, but is being seen only for a monthly b12 injection, the primary diagnosis would be pernicious anemia, not diabetes.
tip 3 – the clinician performing the oasis assessment visit is the person responsible for completing locator 230/240 and assigning the primary diagnosis code after verifying with the physician. although clerical or other professional staff in your office may fill in the icd-9-cm code itself, only the original clinician who filled out the oasis is allowed to make any changes to the diagnoses on the oasis form. if the clinician is making any changes, he/she must correct errors by crossing through with one line and initial and date the correction. any changes made to oasis locator 230/240 that are not initialed and dated by the clinician may be considered alterations to the medical record, and may not be allowed.
tip 4 – our data analysis has revealed that the orthopedic, neurological and diabetes icd-9-cm codes that result in higher reimbursement are being utilized much more frequently now than prior to pps. because up-coding is a vulnerability in the pps program, this is an area we look at closely when reviewing our data; therefore, we encourage you to be sure that you use these categories of codes correctly.
tip 5 – only use the “ open wound” codes from the injury and poisoning category (icd-9 codes 870-897) when there has been a traumatic injury to cause the wound. the documentation should support this occurrence.
tip 6 – specific examples of correct coding are provided by the centers for medicare & medicaidservices (cms) at: http://www.cms.hhs.gov/providers/hhapps/diagnosis.pdf
m0240 secondary diagnosis
tip 1 – only specific neurological and orthopedic codes make a difference in reimbursement when used as a secondary diagnosis. these are codes that cannot be used as a primary code and are indicated in the icd-9-cm book. these secondary, or manifestation codes, must be paired with an appropriate primary diagnosis from the icd-9-cm book to be allowed for additional payment.
