Home Health Articles and Information


Sep 8, 2020 6:00:00 AM / by Kristi Bajer, BSN, RN, COS-C

Is When Your Agency Codes Important?

The legacy practice of home health being ordered as "evaluate and treat' was truly an indication of how disconnected home care once was from the rest of the care continuum.  When I first began as a case manager in home health "evaluate and treat" is the only order I remember seeing.  We went into the patient's home mostly blind to what might have been going on.  I felt lucky when I had an H&P to review before hand.  It was a big responsibility to piece together what disease processes or needs the patient had, and choose interventions and goals to address them.  I know the effectiveness of home health varied greatly from clinician to clinician as well as agency to agency. Further, because we were always playing catch up home health may often have been less effective than it should have been.

In 2011, when the face to face became a requirement, it seemed like an impossible ask.  How were we as home health agencies going to get our referral sources to write a "narrative" on the patient's condition? I recall it being an uphill battle.  Both the community liaisons and intake personal were frustrated. We received complaints  we were the only agency requiring the face to face (of course that wasn't true).  What was worse, over half the face to face documents we did get were incomplete or unacceptable and we had to go back and ask for more documentation.

As the face to face documentation requirements have evolved, we now have a list of diagnoses and conditions requiring intervention from the home health agency along with the disciplines needed for care AND the H&P from the actual visit.  Agencies who have been requiring these documents up front BEFORE ADMISSION are thriving in PDGM and equipped for RCD even if they are not in a demonstration state. It is a hard requirement, but those who have educated their referral sources and then enforced the requirement are reaping the benefits of their hard work now.

If your agency is in this position (or close to it) there is a strong case for frontloading one more thing. 

ICD-10 coding. 

We are calling this "pre-coding".  In pre-coding, the ICD-10 coding is completed when the referral is received BEFORE the clinician does the intake visit. This is helping agencies further streamline their QA processes and produce a POC and RAP much faster.

Reasons why it makes sense

  • -The required information for coding is (should be) contained in the face to face and H&P
  • - It expedites the coding process -which can be days
  • -It focuses the SOC clinician to the reason for the referral- guiding care and further eliminating "eval and treat" 
  • - Matching primary DX and the face to face may help prove medical necessity in CMS audit

If your agency is working to improve efficiency and take care of your patients while increasing cash flow and accuracy,  pre-coding should be seriously considered. 

Tags: PDGM, RCD, Compliance, Home Health, Quality assurance, OASIS, ICD-10 Coding, RAP

Kristi Bajer, BSN, RN, COS-C

Written by Kristi Bajer, BSN, RN, COS-C

Kristi Bajer BSN, RN, COS-C, brings over 10 years of real world experience as a clinician, director, and administrator in home health. She is a firm believer in diagnosis driven evidence-based care in home health. Currently, she assists agencies with external chart audits and Medicare appeals, as well as providing training and coaching on OperaCare implementation and building QAPI programs using data to drive success and protect agencies from government audits.