As a home health agency, you regularly see muscle weakness in patients. But under PDGM, M62.81 (Muscle weakness (generalized)) is not a primary diagnosis, as it doesn’t drive a clinical group. Use these methods to manage the coding change.
Teach staff to identify insufficiencies:
Start with your intake staff and ensure they’re prepared to assign an appropriate primary diagnosis, especially if muscle weakness seems like the first choice. Educate your intake team about what to look for (proper primary diagnosis codes) and when to submit a query before accepting a patient.
Don’t ask leading questions:
Provide the physician with choices and the ability to write a response if no choice is appropriate. For example, instead of asking if the patient’s muscle weakness is due to a recent stay in the hospital for COPD exacerbation, ask what condition is causing this patient to have weakness. Next, provide choices such as “a) COPD exacerbation, b) muscle wasting, c) other condition.” Leave a blank after the option for “other condition.”
Submit a query when needed:
Have coders submit queries to identify the underlying cause of the invalid primary diagnoses. These queries also can’t ask leading questions.
Remember that all home health agencies will now be in the same boat, meaning each agency must have a viable primary diagnosis to submit the RAP.