Archive for 'Did You Know?'
Posted on 02. Jun, 2010 by jan.mater.
After struggling for months to dress herself, your patient decides to modify her clothing choices so that she is no longer dependent on an aide for help.
Do you know how her choice will affect your OASIS C selections? Follow this guidance to ensure you make the correct assessment:
Amount of Assistance is Key
Your responses to items 1810 (Current ability to dress upper body safely…) and 1820 (…lower body…) hinge on two (more…)
Posted on 02. Jun, 2010 by Editor.
The longer an AIDS patient survives his condition, the more they are likely to develop cancers. New research has found high rates of cancers not previously associated with AIDS in the subjects studied. (more…)
Posted on 26. May, 2010 by jan.mater.
Are you sure your notice of election statement covers all the bases? The Office of Inspector General’s (OIG) Fall 2009 report found that that 33 percent of the hospice claims it examined didn’t meet notice of election requirements. Make sure you’re not missing one of the five vital pieces of information that your NOE must cover. (more…)
Posted on 12. May, 2010 by jan.mater.
You’ve heard it said before: Don’t code the symptom when you have a definitive diagnosis. But even when you keep this general guideline in mind, symptoms can still trip you up. Get the final word on when to report symptom codes.
What is a Symptom?
A symptom code is one that describes some sign or symptom that the patient is experiencing without having a diagnosis that confirms the symptom, says Tricia A. Twombly, BSN, RN, HCS-D, CHCE senior education consultant and director of coding with Foundation Management Services in Denton, Texas:
So, if you have a patient who is exhibiting symptoms and they don’t have a more definitive diagnosis it’s appropriate to code for the symptom.
Example: Your patient is experiencing shortness of breath and edema and has no diagnosis that explains those symptoms. In this case, you should code shortness of breath (786.05) and edema (782.3), Twombly says.
However, if the same patient has shortness of breath and edema and also has a diagnosis of congestive heart failure (CHF), then you would only list 428.0 (Congestive heart failure, unspecifed) because shortness of breath and edema are integral to CHF.
What Makes a Symptom Integral?
You shouldn’t code a symptom that’s integral to a disease process, but how do you know when the symptom makes the grade? An integral symptom is one that is associated routinely with a disease process, Twombly says. For example, shortness of breath and edema are routinely part of the disease process of CHF, so they are considered integral to the condition.
Another example: Your patient has liver failure and is experiencing ascites, urticaria, and jaundice. You would only code the liver failure because those symptoms are integral or routinely occur with liver failure (572.8), Twombly says.
But not all symptoms are integral. If your patient has Parkinson’s (332.0) and they are experiencing slurred speech (784.59) you would code both because not all Parkinson’s patients experience slurred speech.
Watch for Exceptions
Sometimes, even though symptoms are integral to the condition you’re instructed to code the symptoms in addition to the condition, Twombly says. For example, your patient has benign hypertrophy of the prostate (BPH) with urinary obstruction (600.01) when you turn to the tabular listing there is a sequencing instruction to “use an additional code to identify symptoms” even though all the listed symptoms are integral to BPH with lower urinary tract symptoms (LUTS).
Posted on 05. May, 2010 by jan.mater.
Family caregivers of patients with dementia usually get depressed due to stress. And they are often left alone to deal with their depression, according to a study conducted by Penn State and the Benjamin Rose Institute.
The study centered on the 15 most common stressors for caregivers, including financial strain, patient behaviors, frequency of help from family and friends, and caregiving time demands. Steven Zarit, professor and chairman of the department of human development and family studies at Penn State, and his colleagues found that the 67 people in the study experienced radically different types and amounts of stress. (more…)
Posted on 05. May, 2010 by jan.mater.
Death is usually neither sudden nor painful — contrary to what many people think, says a palliative care specialist in Canada.
Romayne Gallagher, head of palliative care for Providence Health Care, describes people’s perception of death as one that is based on TV. She also said that family members of a terminally ill patient — often the caregivers themselves — have to deal with a lot of concerns, such as breathing patterns.
“I explain what we normally expect when someone is in palliative care,” Gallagher says in a report published by the Vancouver Courier. (more…)
Posted on 28. Apr, 2010 by jan.mater.
It’s a lonely world out there for sick, aged Americans. About four out of 10 chronically ill older people live alone and rely on others for caregiving. Such findings from a new study say family members should learn how to take care of their ill parents and relatives.
Dr Ann-Marie Rosland, study co-author and clinical lecturer at the University of Michigan (UM) Medical School, thinks that family members could help aging patients with chronic illness manage their conditions. (more…)
Posted on 22. Feb, 2010 by .
Looking for funds to implement electronic medical records at your home health agency? Try hitting up hospitals that want to prevent hospital readmissions just as much as you do.
Integrated EHR just might reduce readmissions, according to the “Breaking Down The Walls of Home Health IT” article published in the latest issue of CMIO. The “CMIO” acronym means “chief medical information officer” of a health system.
Several health systems are experimenting with ways to protect dwindling reimbursement that they think will result when Medicare looks to decrease its current $12 billion hospital readmission bill by bundling readmission costs into the initial visit. Some smart hospitals are seeing that data integration between them and HHAs can reduce “potentially preventable” readmissions for Medicare patients, including those for congestive heart faiture (CHF), diabetes, and COPD (more…)
Posted on 17. Feb, 2010 by .
More hospice claims data means more billing rules for hospice providers. Now that hospices report site-of-service data on their hospice claims, Medicare is going to start editing claims to make sure different levels of hospice care have the correct site, the Centers for Medicare & Medicaid Services says in Feb. 5 Transmittal No. 121 (CR 6778). Starting in July, you can expect to see claims returned if your level of care doesn’t correspond to the correct site of service.
For example: Hospices may furnish general inpatient (GIP) care only in a hospice inpatient unit, a participating hospital, or skilled nursing facility, CMS explains in the transmittal. The system will also check for correct sites for respite care, which must occur in a hospice facility, SNF, regular nursing facility, or participating hospital, and continuous home care (CHC), which must occur at home.
CMS is also correcting its regulations to state that for continuous home care, nursing care from an RN or LPN must make up at least 50 percent of the time billed, CMS adds in Feb. 5 Transmittal 1907 (CR 6778).
Posted on 10. Feb, 2010 by .
Scenario: On Friday you admit Mr. B, a patient with complex needs who is new to your agency. On your second visit on Saturday you compile a list of medications for M2000 (Drug regimen review). Later that day, back in the office, you review the medications and discover a significant medication issue (e.g., side effects that concern the patient). You contact the physician’s office to report your concern and an hour later you receive a call back from the physician on call, who is not the patient’s physician and is unfamiliar with this patient. The on-call physician decides the issue can safely wait and tells you to contact the patient’s regular physician on Monday. How do you answer M2002?
M2002 (Medication follow-up) asks: Was the physician or the physician-designee contacted within one calendar day to resolve clinically significant medication issues, including reconciliation?
Answer choices are 0-No and 1-Yes.
Do you know the answer? Quiz your clinicians before you click ‘read more’ for the answer. (more…)