Hi MHCA Members,
Would anyone know the answer to Marie’s question below? Any guidance would be so appreciated!
Best regards,
Brianna Lindell
Regulatory Affairs & Advocacy Manager
Minnesota Home Care Association
1265 Grey Fox Road, Suite 2 | Arden Hills, MN 55112-6929
Direct: 651.240.3380 | Main:
651.635.0607
www.mnhomecare.org
|
blindell@mnhomecare.org
From: coders@list.mnhomecare.org <coders@list.mnhomecare.org>
On Behalf Of Haas, Marie J
Sent: Wednesday, February 15, 2023 1:10 PM
To: coders@list.mnhomecare.org
Subject: FW: OASIS Coding Question M1021 and M1023
Hi,
I am new to the Listserv, so sorry if this question has been asked before. I have a question if we should include a Diagnoses in M1023 or if we should not include it. In my specific scenario, a patient was seen a month before
being admitted to home care and it was noted by the MD that she had a stage 3 pressure ulcer on her hip and R) lower leg cellulitis with open ulcers on the R) lower legs. Patient was admitted to home care a month later after that clinic visit, the assessing
clinician reports that the stage 3 pressure ulcer is completely healed, but is needing dressing changes for the R) lower leg. There will not be any care plan on the plan of care for the healed pressure ulcer. The patient has not been back to the MD for any
follow up prior to admission to home health. Do we have to include the stage 3 pressure ulcer in M1023 because we don’t have documentation from a provider that it is “resolved”? We would not be coding it under m1306.
Below is the response from CMS when I sent the question to them.
Any advice is much appreciated!
Marie
From: CMS Home Health Quality Questions <cmshomehealthqualityquestions@oasisanswers.com>
Sent: Tuesday, January 31, 2023 3:36 PM
To: Haas, Marie J <Marie.Haas@EssentiaHealth.org>
Cc: CMS Home Health Quality Questions <HomeHealthQualityQuestions@cms.hhs.gov>
Subject: RE: OASIS Coding Question M1021 and M1023
Hello Marie,
Thank you for your inquiry.
M1021/M1023: Primary Diagnosis/Other Diagnoses: The intent of these items is to accurately report and enter ICD-10 CM codes for the patient’s primary (M1021) and other (M1023) home health diagnoses and document
the degree of symptom control for each diagnosis.
OASIS guidance states that M1021 - Primary Diagnosis and M1023 - Other Diagnoses should include only current diagnoses actively addressed in the Plan of Care or that have the
potential to affect the patient’s responsiveness to treatment and rehabilitative prognosis even if not the focus of any home health treatment itself.
Adherence to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10- CM) Official Guidelines for Coding and Reporting when assigning ICD 10 CM diagnosis codes is required
under the Health Insurance Portability and Accountability Act (HIPAA). It is expected that each agency will ensure that diagnoses and ICD-10-CM codes reported in OASIS meet these guidelines.
Questions regarding Medicare payment (eligibility, coverage requirements, PDGM) for home health may be sent to:
HomeHealthPolicy@cms.hhs.gov
Questions related to Medicare PPS reimbursement may be sent to the Home Health Medicare Administrative Contractor (MAC). Information on MAC's can be found at
https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Who-are-the-MACs.html#ABandHH+H .
Thank you for your commitment to home health quality.
The CMS Home Health Quality Help Desk Team
This response is intended to provide guidance related to questions received by the CMS Home Health Quality Help Desk related to quality measures or OASIS. Information contained in this response may be superseded by guidance or specifications
published by CMS at a later date.
Home Health Quality Help Desk: homehealthqualityquestions@cms.hhs.gov
Questions related to: Guidance on OASIS coding and documentation of the OASIS responses; Home Health Quality Measures including, but not limited to: quality manuals, quality measures, measure calculation, Quality of Patient Care Stars,
Home Health Compare, risk adjustment, public reporting, and Quality Assessment Only (QAO)/Pay for Reporting (P4R).
Work performed under CMS Contract No. 75FCMC18D0014, Task Order No. 75FCMC0001
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