Home health coding : Be careful as auditors are keeping a close watch on claims with low vision diagnoses. As such, see to it that your documentation contains the essentials required to earn reimbursement for this case mix condition.
According to Judy Adams, RN, BSN, HCS-D, COS-C, president and CEO of Adams Home Care Consulting in Chapel Hill, N.C, low vision has been a trouble-some diagnosis for a while.
Adams says that when coding for low vision, make sure you’re also listing the diagnoses code for the condition responsible for the low vision. For instance, you can list 362.50 (macular degeneration (senile), unspecified) along with the appropriate code from the 369.xx low vision category if macular degeneration led to your patient’s vision trouble.
Home health coders can stay away from these mistakes:
The medical record must cover the details pertaining to your patient’s low vision. For instance, patient has decreased visual acuity or decreased visual fields.
Moreover, the documentation must demonstrate the impact the low vision has on the patient and her plan of care. How will the clinician address the low vision? Maybe the patient needs someone to help fill her pill box. Or perhaps you’ll be sending in an occupational therapist to help her out with her daily activities. When you maintain such details, it’ll certainly help protect your claims.
Where you go wrong?
Adam says that the most common error related to a low vision diagnosis is basing your diagnosis code assignment on the patient’s scoring vision partially or severely impaired on M0390 (vision with corrective lenses if the patient usually wears them).
So if this is the only documentation you have of your patient’s low vision, it’s not appropriate to list a 369.xx code. M0390 does not address visual acuity; instead it addresses functional vision in the patient’s environment.
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