It has been awhile since I had my hands in billing but here goes.....
You don't have dx codes for specific dates on the same UB....you have fields for 9 codes (I think it is 9) to be listed in order of importance.
I would say if pneumonia was a factor on the 5 day but not on the 14 day the dx code should still be used on the UB....just because it is on the UB does not mean it had to be a factor for ALL the days billed.
Your software should allow the biller to either select specifically which dx codes pull to which dx field on the UB or allow her/him to manipulate dx codes (change the order, add, remove, etc) once they are pulled to the UB. Perhaps your biller could check with the software vendor to see if that is possible with your software.
Nathan <[EMAIL PROTECTED]> wrote:
Software that imports data from other modules, pulls data forward from previous assessments, and other similar functionality is a great timesaver, but usually carries out its functionality based on some very simple rules. These rules may not give an acceptable result 100% of the time. You should ask your vendor to explain how these things work so that you can properly review them each time and decide when the result is appropriate and when it is not.I am not expert on the biling side, so I don't know for sure about the UB-92 rules, but what you are saying about using the same dx even if they are different on the 5 day and 14 seems strange. You need to check with someone that knows the bililng rules better than I do.Nathan----- Original Message -----From: Sally MurphySent: Sunday, February 15, 2004 9:33 AMSubject: Re: Dave AuditThanks, Nathan. So how about I3? Our software automatically imports the top 5 diagnoses we enter into the system into there, or the top 2 for the shortened Medicare form. Do we need to go and re-number those so they don't get imported if we've removed the check from I2 for the 14-day? And our billing person informs me that she has to use the same 9 diagnoses on all UB-92s for the month even if I give her different info for the 14-day than the 5-day. Or aren't we concerned about the billing, just the MDS?
Thanks again, Sally
Nathan wrote:
The condition (pneumonia) does not still affect thier treatment plan. That is like saying someone that had a broken leg 5 years ago, still has a broken leg because they walk with a limp. The after-effects of pneumonia are not an infection and should not be coded that way.Nathan----- Original Message -----From: Sally MurphySent: Saturday, February 14, 2004 7:55 PMSubject: Re: Dave Audit"I2 - Infections
Check an item only if the infection has a relationship to current ADL status, cognitive status, mood and behavior status, medical treatment, nursing monitoring, or risk of death. Do not record any conditions that have been resolved and no longer affect the resident's functional status or care plan."
I copied above from the instructions for I2, and I don't understand why they're making such a big deal over this. I interpret the instructions to say "if the condition affects their functional status or care plan then it's still appropriate". Often it takes six full weeks to recover from pneumonia. So what if they're no longer receiving active treatment like an antibiotic, it's still affecting them, and that's why they're still on Med A.
Somebody please straighten me out.
Thanks, Sally
[EMAIL PROTECTED] wrote:
Our homes participated in the PAAR program, as branch of DAVE, and they founf the biggest error was MDSC's were not resolving off the pneumonia after the first assessment, IE it would be coded on the 5 day and the 14 day and even the 30 day PPS assessment. They had each facility review for accuracy and out of 90 reviews, only one truly had pneumonia after the 5 day assessment. We had 12 facilities in the program.
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