Optional Diagnosis Item M1025: What Home Health Agencies Need to Know

Posted by admin | May 4, 2017 , (0) comments







There are lots of things about the new ICD-10-CM coding guidelines that can be confusing for home health care providers. One of the items that can be difficult for providers to understand as they try to fill out the OASIS form is the Optional Diagnoses item M1025 Section, for which there are two columns: column 3 and column 4.

The most important thing to know about this section on the OASIS form is that it is optional. When the form is submitted to Medicare or Medicaid, any diagnoses coded in column 3 or column 4 will NOT impact payment. The information included on this part of the OASIS form can be helpful for home health agencies that are looking to monitor patient outcomes and accumulate data related to the quality of care, but it ultimately has no impact on the billing and payment processes.

Filling Out the Optional Diagnoses Item M1025 Section of the OASIS Form

 The Optional Diagnoses Item M1025 is relevant only under certain circumstances. Specifically, home health agencies can choose to report an underlying condition in column 3 when a Z-code has been reported in column 2, and the underlying condition for the Z code is column 2 is already a resolved condition. Information is also reported in column 4 in situations of multiple coding; that is, when there is an etiology/manifestation pair.

The ICD-10-CM code for the resolved underlying condition is to be reported in column 3. In column 4, the home health provider can provide ICD-10-CM code for a manifestation of the underlying condition in column 3. However, if multiple diagnosis codes are not required, column 4 may be left blank. When adding information to either column 3 or column 4, it is important to note that V, W, X, Y, and Z codes are not permitted.

For a concrete example, consider the case of a patient who was previously diagnosed with uterine cancer, but who underwent a hysterectomy and therefore no longer requires treatment. Uterine cancer would be the resolved condition, so its ICD-10-CM code would be added to column 3. Any remaining manifestation would be coded in column 4.

Even though the M1025 section is not required for payment, it is important for home health agencies to make sure that all columns on the OASIS form are filled out correctly. AnnexMed can offer OASIS Assessment and Review Services in order to ensure that your forms are in top shape. Contact us today for more information about our offerings.


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