1. Humphrey, Carolyn J. MS, RN, FAAN

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ICD-9 coding has never been something we had to pay a great deal of attention to in cost-reimbursed home care. I confess that I've never been thrilled with agencies requiring nurses to become experts in coding. I believe it can distract from clinical care and detracts from the time needed to keep current with new disease-management strategies and evidence- and research-based information that positively impacts patient outcomes.


PPS has forced me to change my opinion since ICD-9-CM coding must be accurate to assure proper reimbursement. I am convinced that having nurses and financial personnel well versed in OASIS scoring and ICD-9-CM coding is more important than ever. Because OASIS scoring is the key to reimbursement and PPS success is dependent on accurately predicting care needs, costs, and reimbursements through appropriate use of OASIS scoring, nursing expertise is a critical component of "getting it right."


It has been estimated that 40 of the 80 groupers, and as much as $1,800 per episode reimbursement, can be impacted by the answer to one OASIS question. Although it is important for nurses to be well versed in coding, by no means should they be held totally responsible or called upon to be the agency coding experts in the agency.


The expertise of a trained coder as either a consultant, full-time employee, or a staff member whose coding training and ongoing education is supported by the agency is a must. Certified home health coders might also need to have the credentials of Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist and Certified Coding Specialist-Physician based (CCS, CCS-P).


Local universities, colleges, and technical training institutes can be helpful in exploring the resources in your area. They may be looking for clinical practicum sites for students, which would be a great opportunity.


Each state has a health information management association that actively provides coding educational sessions by experts. For more information on your state activities and other information about increasing you agencies expertise, access the American Health Information Management Association (AHIMA) at


I'm happy to be publishing several helpful articles on ICD-9-CM coding in this and an upcoming issue. The two appearing this month are "Avoiding Medicare Denials by Appropriate Coding," by Prinny Rose Abraham, and "ICD-9-CM Coding From a Manager's Perspective," by Peggy Greaves.


In our June 2003 issue an article that will be an ICD-9-CM coding primer is authored by Sue Prophet-Bowman. Ms. Prophet-Bowman is the Director of Coding Policy and Compliance for AHIMA, the association for professionals engaged in health information management (i.e., the coding experts). The article provides thorough definitions and uses home care case studies you can use in your practice.


Home Healthcare Nurse is pleased to help you learn this crucial, challenging role of understanding ICD-9-CM Codes.