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May 2005

Coding in Long-Term Care

Prior to the introduction of the MDS, long-term care facilities did not really focus on ICD-9 coding. The biller only needed one diagnosis code for the UB92. Most of us maintained a disease index, but no one really looked at it. Accuracy was not a main concern and we rarely updated DX codes, no matter how long the resident stayed in our facility. Training basically consisted of “here is the book,
just look it up.”

Now, in post MDS days, coding accuracy and education have taken on a new role. Facilities are focused on empowering staff dealing with ICD-9 to become proficient coders. There are more resources and tools available to long-term care coders today than ever before. Facilities have implemented systems that not only ensure accuracy, but also guarantee that codes are updated at least quarterly. We also maintain a problem or condition list, which allows us to analyze data and better assist in directing care. A good example would be recommending a referral, which improves quality of care and creates positive outcomes for our residents.

Benefits of coding to quality of care are also being sought. At the federal level they expanded the ICD-9 library to include new V codes to provide a more accurate accounting of services or conditions specific to long-term care facility situations.

“We’ve Come a Long Way Baby,” is the phrase I use to describe long-term care ICD-9 coding practices.

Tamela S. McQuiston, RHIT, RAC-C
President, Paramedical Consultants, LLC

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