New and Terminated ICD-9's and impact on Home Care PPS Billing
With the onset of new and terminated ICD9 codes. We begin the yearly ritual related to their use on episode that cross Oct 1. The impact on Home Care Billing is clear with denials and/or suspensions likely. The rule of thumb here is for PPS episodes that cross Oct 1, NEVER use a new or terminated diagnosis PERIOD. If you have one in there, you must remove it as it will cause an issue. The reasons are quite simple. RAPS and FINALS do not follow the same rules. Basically CMS edits look at diagnosis codes at the beginning of the Episode for RAPS and at the END for FINALS. Therefore an code which is perfectly valid on day 1 but is terminated prior to day 60 will lead to a denied FINAL. Therefore if you have one. Back out the orders. Cancel the RAP and find a suitable replacement that is NOT one of the new ones.