PIVOT Points

Don’t let lack of reimbursement stop you from coding psych care

Agencies will continue to go without extra reimbursement for common psych diagnoses like depression in ICD-10. But don’t let that stop you from coding an important part of a patient’s care, as it will only confirm CMS’ suspicion that these conditions don’t impact resource use.
The 201 ICD-9 diagnosis codes for which you lost case-mix points this year, such those in the pulmonary, blindness/low vision and psych categories, aren’t coming back with ICD-10, according to the home health payment logic (grouper) posted June 2. The grouper logic is what’s used to determine home health payments effective Oct. 1.
Psych diagnoses are one area in which CMS thinks the home health industry has been gaming the system, says Trish Twombly, senior director for DecisionHealth in Gaithersburg, Md.
The federal agency has long believed that home health does not treat psych diagnoses and has only been assigning them among the top six diagnoses on claims so that they could earn the extra money that came with them, she says.
The reality is, however, that home health does see these diagnoses — quite often, in fact — and does provide interventions for them as they can have a significant impact on a patient’s health status, says Vonnie Blevins, coding and billing manager for Excellence Healthcare in Houston.
The problem is, seldom does significant evidence of this make it in the charts that CMS reviews, Twombly says.
“Clinicians do a lot more than they show in their documentation,” Blevins agrees.
Depression (F32.-), anxiety (F41.-), bipolar disorder (F31.-) and dementia (F03.-) are the most common psych diagnoses Blevins sees and assigns to claims. All of those diagnoses lost their case-mix value in the 2015 PPS rule, and none will have those points returned in ICD-10.

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