October 1, 2020 is just around the corner, meaning it’s time for the Centers for Medicare and Medicaid Services (CMS) to release the home health ICD-10-CM update files for FY 2021. Per the CMS website, “These 2021 ICD-10-CM codes are to be used for discharges occurring from October 1, 2020 through September 30, 2021 and for patient encounters occurring from October 1, 2020 through September 30, 2021”.

This information from CMS can leave agencies with multiple questions regarding the changes. What does this mean for home health agencies? How will this impact final claims? Will the new ICD-10 codes impact OASIS submissions? Learn more about the updates and how your agency can prepare for CMS’s changes.

ICD-10 code changes

The updated ICD-10 code set includes 490 new codes, 58 deleted codes and 47 revised codes. This takes the total number of ICD-10 codes in FY 2020 from 72,184 to 72,616 in FY 2021. Some commonly used codes in home health that were updated include:

  • Sickle-cell anemia,
  • Substance abuse, use codes for (alcohol, cocaine, opioid, cannabis),
  • Interstitial lung disease with fibrosis,
  • Esophagitis and gastro-esophageal reflux disease with and without bleeding,
  • Hepatic fibrosis specified as early or advanced,
  • Rheumatoid arthritis to include other specified site,
  • Other and unspecified osteoarthritis other specified site,
  • Osteoporosis, age-related and other, to include other specified site,
  • Chronic kidney disease stage 3 to include stage 3a and stage 3b,
  • Headache to include an orthostatic component, and
  • Poisoning by, adverse effect of and underdosing of fentanyl, tramadol and other synthetic narcotics

How to prepare your home health agency

As an agency, it’s important to ensure you are communicating clearly with your electronic medical record vendor to ascertain when the code set will be updated in both the clinical and billing software. With the Patient-Driven Grouping Model (PDGM) requiring 30-day payment periods, all final claims submitted with services provided on or after October 1, 2020 will require the new ICD-10 codes. September 2, 2020 marks the beginning of the 30-day payment period with the potential for services to be provided on or after October 1, 2020. Identify any potential patients that will receive services on or after October 1, 2020. The new ICD-10 codes will need to be updated on the final claim only. The codes will be updated on any OASIS data collections on or after October 1, 2020.

Want to learn more about how McBee can help your home health agency prepare for the ICD-10 updates? Get in touch to learn about our custom-tailored OASIS accuracy and coding outsource services to help you adjust coding processes and thrive under new CMS updates.

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McBee Episode Management Services help home health organizations optimize visit and discipline utilization to achieve clinical excellence and ensure financial viability. With a patient-centric approach, our clinical consultants provide your organization with insights into your utilization management to identify trends, optimize areas of improvement, and recommend next best steps to integrate new care patterns into your culture.
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