The purpose of expanding the number of diagnoses was to give the home health agency (HHA) the opportunity to report on comorbidities and risk factors affecting patient care, the possible need for more services and, with it, the necessary additional reimbursement. As long as your choice of diagnoses is supported by the doctor's in-person documentation or documentation of discharge from the hospital or doctor's office, you can encode these diagnoses in your OASIS evaluation. ICD 10 The main reason for Home Care in Clearwater FL, that is, the OASIS M1021 product, is always the primary diagnosis. The doctor who signs the care plan (CMS48), that is, the “certifying” doctor (as opposed to the “referring doctor”) always determines the primary diagnosis and documents it during the face-to-face meeting required by Medicare. The “in-person doctor” is a mandatory Medicare regulation for initiating Home Care in Clearwater FL services. It is NOT required for recertification.
The HHA should consult with the doctor to identify an appropriate substitute that meets this requirement. If Medicare audits a patient's medical record, you must ensure that the doctor or hospital can verify all diagnoses. MDS clinicians and the nursing administration must work at the same time as the physical therapist, otolaryngologist and nursing surgeon professionals to answer the “why” question, and only then should the primary diagnosis be chosen. Many people define the primary diagnosis as the diagnosis for which they “bought the bed” or the diagnosis that led the doctor to decide to admit the patient.
If a diagnostic code is NOT included in the description, the HHA must select the code that best represents the description of the problem provided in the description of the problem. However, we cannot use the IAMCEST as the primary diagnosis because it was not the “condition” that motivated the admission. The main diagnosis must be specific enough in the ICD-10 coding terminology so that it does not result in an RTP (return to the provider) due to lack of specificity, and must also be addressed in the patient's medical record on a regular basis to legitimate its use to bill for the services provided. Usually, the primary diagnosis and the primary diagnosis are the same diagnosis, but this is not always the case.
Identifying the primary and secondary diagnoses can be confusing when a patient is admitted with two or more acute problems, such as a patient admitted for aspiration pneumonia and an acute stroke. This is the diagnosis that brought the patient to the hospital and the diagnosis that made him need an inpatient bed. Therefore, a timely and thorough clinical evaluation of each new admission is crucial to establish the primary diagnosis. In the PDPM, the primary diagnosis obtained in the initial evaluation of the MDS determines the flavor of the stay, especially the amount that CMS pay at the time to pay.
Rather, if a gait abnormality is related to a neurological diagnosis, such as Parkinson's disease (G20), Medicare will expect the neurological diagnosis to be the primary one. To avoid being bothered by home health agencies for obtaining more definitive codes, you should use the most specific diagnosis possible when requesting home health services for your Medicare patients.
