OASIS-Central

Diagnoses play an important role in supporting reasonable and necessary services. The diagnoses must correlate with the services the agency provides. The primary support for the patient’s plan of care comes from the principal diagnosis. The pertinent diagnoses listed first can also support the plan. Other diagnoses identify relevant comorbidities. Any of the six reported in M1020, primary diagnosis, and M1022, other diagnoses, can be case-mix. Because diagnoses support reasonable and necessary services and add points to increase payment, it must be the physician who authorizes the diagnoses.

There are many ways to obtain the physician’s agreement with the diagnoses.

• List the diagnoses in the verbal orders to start care.

• Contact the physician to discuss any diagnosis that may not be on the referral and document that discussion. Example: During drug regimen review, the nurse finds two cardiac medications. However, the referral does not mention any cardiac diagnoses. The patient says she was hospitalized for heart failure two years ago. The nurse verified this diagnosis with the physician and listed it as a pertinent diagnosis on the plan of care.

• Document in a verbal order any new diagnoses that affect the plan of care. Example: The patient sprained her ankle and the physician ordered a physical therapy evaluation. In the verbal order for the evaluation, the nurse notes the new diagnosis.

• Identify a new principal diagnosis in a verbal order or resumption-of-care order if the primary reason for seeing the patient changes as a result of a change in condition or a hospitalization. Report that diagnosis in M1020 on the update assessment and carry it over into Locator 11 on the recertification plan of care, if appropriate.

Also note: It is important to have the physician’s agreement with any diagnosis reported in M1024, payment diagnoses.

Beacon Health’s audio conference on August 10 will provide strategies for diagnoses selection, coding, and documentation. Get the details at — http://www.beaconhealth.org/cgi-bin/ccp51/cp-app.cgi?pg=prod&ref=J081010A.

This article is from yesterday’s edition of Homecare Insider. Sign up for the free newsletter today!