Coding Tip from Sparkle Sparks: Acute Diagnoses in Home Health

Sparkle Sparks

Check out the free coding tip below discussing Acute Diagnoses in Home Health, provided by OASIS Answers’ Sparkle Sparks, PT, MPT, COS-C.

Join Sparkle for The Art of ICD-9 Coding workshops in Orlando on March 22nd (Beginning), 23rd (Intermediate) and 24th (Advanced).

Acute Diagnoses in Home Health

When I am teaching coding workshops one comment always seems to come up and that is, “I thought home health coders couldn’t use acute codes.” That statement is only partially correct. There is no moratorium on the use of acute diagnostic codes in home health. However, there are certain conditions that in their acute forms would render a patient too sick to be cared for in the home, like acute pancreatitis. There are also coding restrictions that forbid the use of the acute code once the patient has received “active treatment” like acute fractures (Chapter Specific Coding Guidelines I.C.17.b.1).

We also now know that home health should have never been using acute CVA codes if you only consider coding guidance, but that we did it for a while (2000 – 2007) to ensure proper reimbursement in the original version of the Medicare Prospective Payment System for Home Health. While we routinely care for stroke patients in home health we’re really managing the neurological deficits created by the stroke. We don’t treat the patient during the onset/evolution of the stroke which is why we must use the “Late effects of CV disease codes.” The 2008 version of PPS updated the case mix diagnosis list to reflect this by adding category 438, Late effect CV disease and deleting the acute CVA codes classifiable to 430 – 437.

Aside from these examples, other acute diagnostic codes may be used in home health when the medical documentation supports their use.


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