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The $930.47 Coding Mistake: Understanding OASIS and Coding Standards

This piece discusses the critical coding mistakes affecting reimbursement in therapy services, particularly for patients with complex needs like Mr. X, a 68-year-old with CVA, hypertension, diabetes, and depression. It illustrates how accurate coding in patient assessments can prevent financial losses, highlighting the importance of thorough evaluation of comorbidities and proper documentation. By uncovering one simple coding error worth $930.47, the article prompts healthcare providers to audit their coding practices and ensure adherence to CMS expectations for OASIS and accurate billing.

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The $930.47 Coding Mistake: Understanding OASIS and Coding Standards

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  1. The $930.47 Coding Mistake * Source : CMS Expectations for OASIS and Coding : www.mtha.org

  2. Patient History • Mr. X, 68 years, was referred for PT & OT after an acute CVA w/ hemiplegia of the dominant side. The referral also states he has HTN, CHF, diabetes, & depression. • His BP was elevated in the hospital & he was placed on Enalapril 10 mg. podaily. Prior to the CVA he was very active in community affairs & maintained the exterior of his house & 2 acre yard. • When the intake staff asked about skilled nursing, the MD declined stating Mr. X’s BP is under control & he only needs therapy.

  3. PT Assessment • BP 170/85, & PT was instructed about new meds in the hospital & understands what it’s for & how to take it. • He has dyspnea w/ moderate exertion & 1+ edema of lower extremities • He has had diabetes for years but has not been medicated for it – it’s strictly dietary control • He had a positive screening for depression using PHQ-2 scale @ M1730 & is on antidepressants

  4. Functional Assessment • M1800 Grooming: 2, requires assistance • M1820/M1820 Dressing: 2, requires assistance • M1830 Bathing: 5, unable to get into shower/tub & requires assistance w/ bath • M1840 Toilet transferring: 2, uses BSC • M1850 Transferring: 2, unable to transfer self • M1860 Ambulation: 3, requires supervision or assistance • 1st Medicare episode, & 10 PT & 6 OT visits are ordered.

  5. Justification for Coding Co-Morbidities • Under Standards of Good Practice, the therapist takes BP & asks about blood sugars w/ each visit to evaluate the effect of increased exercise on HTN & diabetes, as well as monitoring impact of depression on Mr. X’s motivation to participate in the rehab program.

  6. Coder only codes Therapy diagnosis

  7. When Coded Correctly

  8. One Coding Mistake is worth $930.47! How many similar mistakes are in your records? Care to find out? Act Now! 1.877.446.6825

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