Beware of Adult Failure to Thrive and Debility as Primary Hospice Diagnosis

The Proposed Hospice Wage Index and Payment Rules that were published on May 8, 2013 included many other items for the hospice industry.  We have received phone calls and emails concerning the Adult Failure to Thrive code (783.7) and Debility code (799.3) as the primary diagnosis code for hospice patients.  In the proposed rule CMS states that Adult Failure to Thrive and Debility cannot be used as the primary diagnosis code.  They could be utilized as a secondary diagnosis code.  The proposed rule (see link below) goes into detail on page 27830 through 27834 concerning diagnosis coding.  The latest claims data available show that over 70% of hospice claims only utilize one diagnosis code.  CMS will begin require much more detailed coding now and in the future.

Of primary concern for hospice’s today is CMS plans to immediately implement that the Adult Failure to Thrive and Debility codes cannot be utilized as primary diagnosis. This was stated by CMS in the Hospice Open Door Forum Meeting on May 8^th.   CMS stated that this only clarifying existing policy and guidelines.  CMS is developing a special edit that will return all claims to hospice’s that have Adult Failure to Thrive or Debility as their primary diagnosis.  They have not released a date when the edit will become effective.  We will notify our newsletter subscribers as soon as we find that date the edit will be released.

We encourage all hospices’ to carefully review their coding and immediately stop utilizing Adult Failure to Thrive and Debility as the primary hospice diagnosis.  We understand that coding can be very confusing and difficult to understand.  We will have two speakers at our Hawaii seminar in September 18^th to 20^th to provide more detailed information on hospice coding and other important issues.  For more information about our upcoming Hawaii Seminar please see the information listed below this email.

To obtain a copy of the Proposed Hospice Wage Index and Payment Rules that were published on May 8, 2013 please click on the link below:

http://www.gpo.gov/fdsys/pkg/FR-2013-05-10/pdf/2013-10389.pdf