Top 5 Common Coding Errors in Hospice Care and How to Avoid Them

Ensuring accurate coding practices is crucial for maintaining compliance, securing proper reimbursement, and providing high-quality patient care. In hospice care, coding errors can have significant consequences, potentially leading to costly audits and compromised patient outcomes. This blog post will delve into the top five common coding errors in hospice care and provide practical strategies to avoid them.

1. Incorrect Terminal Diagnosis Coding in Hospice

One of the most critical aspects of hospice coding is accurately identifying and reporting the terminal diagnosis. This diagnosis forms the foundation of the patient’s care plan and determines eligibility for hospice services.

Common Errors:

• Using non-specific codes when more detailed information is available
• Listing symptom codes as the primary diagnosis instead of the underlying condition
• Utilizing prohibited principal diagnoses, such as Z-codes

How to Avoid:

• Ensure the terminal diagnosis is determined and certified by the attending physician or hospice medical director
• Review the entire medical record to identify the specific reason for hospice admission
• Use the most specific ICD-10-CM code available based on the documented diagnosis
• Avoid using symptom codes as the primary diagnosis when a definitive diagnosis is known
• Familiarize yourself with the list of prohibited principal diagnoses and avoid using them as the terminal diagnosis

2. Failure to Code Related Conditions

Hospice care often involves managing multiple conditions related to the terminal illness. Failing to code these related conditions can lead to incomplete care plans and potential reimbursement issues.

Common Errors:

• Listing only the terminal condition on the Plan of Care
• Omitting conditions that co-exist or impact the patient’s care
• Failing to code conditions that may affect the patient’s response to treatment

How to Avoid:

• Conduct a thorough review of the patient’s medical history and current conditions
• Include all clinically significant diagnoses on hospice claims, not just the terminal diagnosis
• Ensure that the care plan addresses all related conditions
• Regularly update the list of diagnoses as the patient’s condition changes
• Implement a system for clear communication between the clinical team and coding staff to capture all relevant conditions

3. Incorrect Use of Combination Codes

Combination codes in ICD-10-CM represent two or more conditions that are commonly associated. Misusing these codes can lead to inaccurate representation of the patient’s condition and potential billing errors.

Common Errors:

• Separately coding conditions that should be reported with a single combination code
• Misunderstanding the correct use of combination codes for conditions like hypertension, chronic kidney disease, and heart failure

How to Avoid:

• Thoroughly review the ICD-10-CM guidelines for combination codes
• Provide ongoing education for coding staff on the proper use of combination codes
• Implement coding software that flags potential combination code opportunities
• Conduct regular audits to identify and correct combination code errors
• Consult with experienced coders or coding specialists when dealing with complex cases

4. Improper Sequencing of Codes

The order in which diagnoses are listed on hospice claims is crucial. Improper sequencing can lead to denied claims and misrepresenting the patient’s primary condition.

Common Errors:

• Listing a related condition as the primary diagnosis instead of the terminal illness
• Incorrectly sequencing primary and secondary cancer codes
• Misunderstanding the coding rules for conditions like end-stage liver disease or heart failure

How to Avoid:

• Ensure that the terminal diagnosis is always listed as the primary diagnosis on hospice claims
• Follow ICD-10-CM guidelines for sequencing specific conditions, such as cancer codes
• Provide regular training on proper code sequencing for hospice-specific scenarios
• Implement a quality assurance process to review code sequencing before claim submission
• Utilize coding software that assists with proper sequencing based on hospice-specific rules

5. Inconsistent Diagnosis Coding Across Documentation

Consistency in diagnosis coding across all hospice documentation is essential for compliance and accurate representation of the patient’s condition.

Common Errors:

• Discrepancies between the diagnosis listed on the Certificate of Terminal Illness (CTI), care plan, and UB-04 claim form
• Inconsistent use of codes for the same condition across different documents
• Failure to update all relevant documentation when the patient’s condition changes

How to Avoid:

• Implement a standardized process for ensuring consistency across all documentation
• Regularly cross-check the primary terminal diagnosis on the CTI, care plan, and claim form
• Utilize electronic health record (EHR) systems that automatically populate diagnoses across different forms
• Conduct periodic audits to identify and rectify any inconsistencies in diagnosis coding
• Establish clear communication channels between clinical staff, coders, and billing personnel to ensure all parties are aware of any changes in the patient’s condition.

Strategies for Overall Improvement in Hospice Coding

To address these common coding errors and improve overall coding accuracy in hospice care, consider implementing the following strategies:

1. Invest in Ongoing Education: Provide regular training sessions for coding staff, clinicians, and other relevant team members on hospice-specific coding guidelines, updates to ICD-10-CM, and best practices in documentation.
2. Leverage Technology: Implement advanced coding software and analytics tools that can help identify potential errors, streamline the coding process, and provide insights into coding patterns affecting reimbursement rates.
3. Conduct Regular Audits: Establish a routine internal auditing process to review coding accuracy, identify trends in errors, and implement corrective actions.