Meeting the Hospice Coding Challenge

2016 Hospice Wage Index states to code ALL unresolved diagnoses on a hospice patient’s claim, not just those related to the terminal diagnosis. The Index stated the importance of a comprehensive approach to the hospice patient’s care. You should code all diagnoses related to the terminal diagnosis and all diagnoses that are not related to the terminal diagnosis. This coding could help support the terminal condition of the patient. The Medical Director and the clinician decide on and document the primary terminal diagnosis and the secondary diagnoses before the assessment goes to the coder. Many software systems require the related diagnoses be entered prior to the unrelated diagnoses, so it is helpful if the diagnoses are listed in that order for the coder. It could also save time in having to go back and re-sequence the codes.

Hospice Must Follow All Coding Rules And Guidelines
The primary and all other diagnoses must be as specific as possible. Ex: unspecified cerebrovascular disease is not a preferred code-you need to query the physician, the Medical Director and the IDG to get a more specific code if possible. If the patient has more than one chronic diagnosis or symptomatic condition that, when combined, lead to the patient having a life expectancy of six months or less the IDG makes a clinical decision on which is the most contributory to the terminal prognosis. If the clinician/Medial Director states ESRD is the primary terminal diagnosis and the patient has HTN, the HTN in CKD is coded following coding guidelines– HTN must be coded prior to CKD. In this case the ESRD is the terminal diagnosis, the HTN is the primary diagnosis, and coded I12.0 followed by N18.6.

Specific Patient Information Upon Referral
Getting the specific information and diagnoses in the referral info is so necessary to coding. Resources can include:
– H&P, consultation reports, FTF, DC summaries from physicians
– Intake staff need to work closely with referral sources to get as complete information as possible at referral
– Request the documents you need that will give the best physician confirmed information and diagnoses.
– Look for underlying disease processes, e.g. is vascular dementia the sequela of CVA with cognitive residuals?

Physician Confirmation of Diagnoses
All diagnoses on the plan of care must be documented in the medical record by the physician. If the diagnoses are not in the documents mentioned above the agency must document that the diagnoses were confirmed by the physician. Diagnoses are not coded based solely on the clinician documentation, medications, treatments, or patient/caregiver report.

There are only 3 items that can be coded based on the clinician’s assessment and documentation.
1. BMI
2. Stage of pressure injury
3. Depth of tissue damage in a non pressure chronic ulcer

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Meeting the Hospice Coding Challenge
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