Home health care agencies and other providers can make judgment calls in when to use certain ICD-10 codes that in most circumstances are not meant to appear together, according to interim guidance issued Monday by the National Center for Health Statistics (NCHS).
At issue is the “Excludes1” note, which indicates when two conditions cannot be coded together—in the example given in the new guidance, the code range I60-I69 for cerebrovascular diseases has an Excludes1 note for intracranial hemorrhage (S06.-). This indicates that when a patient presents with a stroke, for example, that individual cannot also be coded for a hemorrhage caused by a traumatic injury.
“In a hospital setting, that could be an issue, because they might have a patient who has had a stroke in the past, and they have a subsequent intracranial hemorrhage they come in with,” Jennifer Gibson, RN, a certified coding specialist who conducts trainings for Axxess, told Home Health Care News. Axxess is a home health software vendor based in Dallas.
In the case described by Gibson, it may be appropriate to code both for S06- and I69-, which is the code for sequela from a previous stroke.
While I69- is a code that home health providers are very familiar with, Gibson said she has not heard that this Excludes1 issue has been of particular concern to home health providers. But she chalks that up in part of the lack of specificity in codes from home health referral sources; she expects that with the implementation of ICD-10, a much more specific code set than its predecessor, that might begin to change.
She added that regardless of the code set being used, home health providers still face a more basic challenge—simply getting discharge summaries and other medical records information from hospitals and other referrers.
“It’s all about logistics,” she said. “Getting your hands on the actual information.”
Written by Tim Mullaney