Diagnosis Coding Guidelines and Conventions
Presented by Michael Tidd
Diagnosis coding is essential for all medical settings. It is essential to know the details contained in the guidelines and conventions to ensure that your coding is complete and accurate. It is essential to know the PDGM Case-Mix model for Home Health to ensure you are paid correctly. While may agencies think they are coding compliantly because they copy the diagnosis codes from the inpatient setting, they may not be following the guidelines and most likely are not receiving the correct reimbursement under home health. Hospitals, skilled nursing facilities and rehab centers are not paid the same way home health is and as such their coding practices are different. Simply copying coding from the H&P will typically allow the agency to bill, but will not always generate the highest reimbursement for home health billing.
This class will provide instruction on the current coding guidelines and conventions and provide additional references to ensure your agency knows how to code properly and eliminate rejections by iQIES and the Medicare Administrator Contractors when submitting OASIS and claims. The coding guidelines and conventions are applicable to all billing practices and thus this class will provide training for beginners or a refresher to experienced diagnoses coders. This course will provide the fundamentals, understanding and use of the coding guidelines and manual so that you can begin diagnosis coding and gives the essential understanding of home health billing practices to receive the highest reimbursement under PDGM.
- Understand the Coding Guidelines
- Understand the Coding conventions
- Learn how to use the diagnoses coding manual
- Verbalize the process of using the coding manual to properly select a disease diagnosis provided by the physician to obtain the correct ICD-10-CM code
- Demonstrate your knowledge by correctly coding scenarios
- Verbalize the use of Excludes 1 and Excludes 2 notes.
- Verbalize the proper actions when Code First and Use Additional code appear in the coding manual
- Identify the terms required to use when looking up a diagnosis in the coding manual
- Verbalize the proper action when seeing See or See Also in the coding manual alphabetic index
- Discuss what the coding guidelines provide with regard to etiology and manifestations of a disease and how to sequence diagnosis codes
Michael Tidd has over 20 years of experience in the Home Care Industry and is a frequent speaker at HealthCare Synergy Workshops and Webinars. He is a Software Developer, LVN, and Certified in ICD-9/10 Coding and OASIS (COS-C, HCS-D). As the Clinical Manager for HealthCare Synergy, he directs the Outsourced Management Services, assists in directing the development of the Healthcare Assistant Web Edition, oversees the Clinical Documentation Auditing provided to clients, and directs the Clinical Form Development for the Healthcare Assistant Web Edition. Michael continues to educate agencies on the ongoing regulations that CMS produces, the proper application of the Medicare Conditions of Participation, and completing timely, accurate, and defendable clinical documentation to survive in the current Medicare Reimbursement Model.