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IRF Coding Points to Ponder

Written by: Darlene D'Altorio-Jones (1959-2015) on Wednesday, March 12, 2014 Posted in: Inpatient Rehab

A Recap of IRF Coding that Makes Sense

As we continue to provide opportunities to learn more about ICD-10 coding, we want persons to remember that it’s never too late to be certain that what you are doing now is correct.  Simple steps to improve coding accuracy for IRF will help you as you transition toward future ICD-10 practices.

I hope you were able to join our Mediware webinar recently when Paula Digsby, CCS, CPC, CPCI, AHIMA Approved ICD-10-CM/PCS Trainer provided an extremely informative inservice entitled: “Avoid the Potholes- IRF Coding with ICD-9”.  If not, that link will also give you information to sign up for future education coming later this month.

There were so many insightful and helpful hints offered in the inservice.  Here is a list of some reminders and hints Paula highlighted that will be sure to improve your coding accuracy!

  • Be certain your IGC and Etiologic Diagnosis describe the underlying condition that CAUSED the impairment that necessitates the IRF admission.
  • Be certain that interruptions of 3 days or less (Midnight Rule) are combined into ONE uniform bill. Often EMRs insist that two separate encounters are formed with unique ID’s, but with final discharge these must be reflected as one episode for Medicare part A billing purposes.
  • Procedure coding does NOT belong on the IRF PAI.
  • Beware of ‘historical vs. current’ conditions that may also have been historical. In an H&P, historical co-morbid conditions still being managed must be identified by the doctor to enable placement on the IRF-PAI and the uniform bill.
  • With more than 50 codes for diabetes and up to 300 coming with ICD-10, be certain your physicians are using the most descriptive symptoms or ‘manifestations’ of the disease.
  • Any poorly ‘controlled’ symptom/diagnosis is STILL CONTROLLED -use ‘UNCONTROLLED’ when it is. Use the word ‘fluctuating’ when a status does and requires close monitoring!
  • Whenever possible, associate the diabetes with the associated problems it has created, (diabetic retinopathy was the example Paula used).
  • Co-morbid conditions can exist at admission, be discovered and treated during the stay and have impact on treatments/orders and length of stay.
  • Do not use ‘history of pneumonia’ when it is still being treated. Query the physician for specifics if you know pneumonia was listed as ‘history of’ but medications are still being utilized to treat it.
  • Possible, probable and suspected are ‘not confirmed’ symptoms/diagnoses. If you are expending resources to mitigate a condition – state the impact of that care.
  • Recently ‘discharged’ conditions may still require resources or care. Example; recently dicharged tracheostomy in an H&P is better to state the date of decannulation and that continued care is required for stoma healing. It may be the difference between highest tier or no tier in the HIPPS code.
  • Query physician to state morbid obesity if the patient’s weight meets the definition.  BMI of 40 or more can be tiered.
  • Items often missed for tiering include: cellulitis, acute renal conditions, post op infections still being treated, morbid obesity, CHF and diabetes with manifestations.
  • Utilize words like: treated for, impacted, extend stay for, monitoring results of and providing resources for…
  • Be certain to be specific about spinal conditions and causes for admission; getting these right will impact the corrrect IGC/RIC.
  • Be very careful before using the condition of ‘Debility’; what was the reason for the acute care stay? Often this will lead to better etiologic condition(s).
  • Every discipline should address in their notes the continued attention they provide in the care of any of the co-morbid conditions.
  • Follow these simple rules and it will help to defend medical necessity in your documentation.
  • Don’t forget to associate the list of medications with the conditions they are treating.  This helps to capture all ‘present’ conditions utilizing resources.
  • Be sure documentation states what you observed and provide the detail of those observations and their impact on the patient’s ability to recover.

If this list sparks your interest to learn more, be sure to follow the link to download this inservice and stay tuned as Paula provides three more opportunities in correct coding – now through ICD-10!

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