Possible Home Health Grouper Issues Discovered

Certain Diagnosis Codes Affected.

HEALTHCAREfirst would like to make home health agencies aware of an issue that was included in an article posted by the National Association of Homecare and Hospice (NAHC).

NAHC reported back in an August 21st article that, “Clarification has been issued that would require home health agencies to indicate an ‘A’ (initial encounter) in the 7th character for some ICD-10 codes. An ‘A’ in the 7th character should be used for any encounter where the patient is still receiving active treatment for the clinical condition, including home health. While in many cases this would not apply to home health, there are times where it could, such as antibiotic treatment for a post-op infection.”

NAHC also stated, “The 2015 Grouper, effective for claims spanning October 1– December 31, 2015, does not allow for case mix and non-routine supply (NRS) points for any ICD-10 code with an ‘A’ in the 7th character.”

HEALTHCAREfirst consultant Mary St Pierre recently asked CMS for clarification on this issue.  Other industry observers had reported that Medicare Administrative Contractors might have edits that would reject such claims from home health providers.  CMS verified there are no claims processing edits related to ICD10 codes with the added ‘A’.  CMS describes the issue as a Grouper issue that “payment policy” is working on.

Both NAHC and HEALTHCAREfirst are awaiting further instruction on this topic and will advise customers immediately when further instructions are available.

Click here to see the full NAHC article for additional details.

September 25, 2015

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