Coding Hospital GIP's

diata11

Our hospice has a fair number of hospital GIP admissions in a large city area. The diagnosis vary from CVA, ICH, traumatic and non-traumatic SDH (bleeds versus falls), to hangings, suicides and GSW. Often the patient has been in the hospital for a lengthy period of time (say more than two weeks.) We follow the guidelines to the best of our understanding, but often feel confused as to sequencing and actual diagnosis based on the time frame. How do other city area hospices approach this issue? It would be nice to have an AHCC monthly topic on this.

Jmilliman

Thanks so much for this topic suggestion.

Jmilliman

Hello again.
Just wanted to check back in with an update. We reached out to a hospice coding expert and received the following answer to your question:

1. CVA’s – The only time you can use the acute CVA code in Hospice is when it is due to a non-traumatic hemorrhage that a)continues to bleed and b)the patient/family does not want interventions to stop the bleed. All other cases, we use the late effect codes that identify the residual deficits the patient is experiencing due to the CVA
2. For traumatic ICH you can use the appropriate S06.- codes to identify the specific injury
3. For the GSW’s, I would code the specific wound in addition to any other conditions related to the GSW
4. For the hangings and suicide attempts, there are T codes that indicate the cause and effect with the use of the appropriate 7th character. An example is T71.162D – Asphyxiation due to hanging, intentional self-harm, subsequent encounter

The key is that the diagnosis is the condition most contributory to the prognosis of 6 months or less as identified by the Hospice physician and the attending and the documentation supports the need for Hospice. And when coding the terminal diagnosis and the other comorbidities, follow coding guidelines and conventions unless otherwise directed by the state if Medicaid is involved. Some states have their own specific requirements with Medicaid and some private payers also have differing requirements when coding the terminal diagnosis.

Hope that's helpful!

diata11

Thank you for your response! It is helpful and good to know that we have been doing things correctly!