Ensuring Compliance of Coding Guidelines for Home Health Agencies

Home Health Billing Edits.

CMS recently announced they are creating new billing edits that will go into effect January 1, 2015 for Home Health Agencies to ensure greater compliance of coding guidelines for primary diagnosis codes.

The principal diagnosis reported on the home health claim should be the ICD-9-CM code that is most related to the current home health plan of care. HHAs should not submit manifestation codes as the primary diagnosis. The Medicare Administrative Contractors are being instructed to apply edit 86 for “Manifestation code as principal diagnosis” to home health RAPs and claims (Type of Bill 032x) with dates of service on or after January 1, 2015.

Home Health Agencies should review their coding practices and advise coding and billing staff of these upcoming changes.

The Medlearn Matters article can be accessed here.

The change request can be accessed here.