Homecare Update
(From the September 2025 Issue of MedStat)
Diagnosis Code Update for Homecare Referrals
The goal of Nationwide Children's Homecare is to make the referral process as easy as possible. Third-party payors are increasingly placing new coding demands on referring providers, which can be both burdensome and confusing.
This article is meant to support you and your practice by helping minimize unnecessary emails and reduce delays in patient care. The Homecare team is actively developing additional tools and resources to further simplify the referral process and reduce confusion. Below are the three most common coding issues that frequently hold up the prior authorization approval process:
- Unspecified Diagnosis Code
An unspecified code is a diagnostic code used when the documentation in the patient's medical record lacks sufficient detail to assign a more specific code. This means the general category of the condition is known, but key information — such as the exact type, location (e.g., left or right) or severity — is missing. Providing specific information is essential for approval.
- Z-Diagnosis Code Denials in the Primary Position
Z codes may not be considered appropriate as the sole or principal diagnosis for billing purposes in Ohio, as they generally indicate factors influencing health status rather than a primary illness or injury.
- Two Conditions Billed as a Single Diagnosis
An Excludes1 is used when two conditions cannot occur together, such as coding to bill for a congenital and an acquired form of a disease under the same code.
An Excludes1 indicates that the code excluded should never be used at the same time as the code above the Excludes1 note.
For questions about Nationwide Children's Homecare services or programs, email Carolyn.Figi@NationwideChildrens.org.
Reminder: Nationwide Children's Homecare has now been serving children in the Toledo region for over a year. Visit the Nationwide Children’s Toledo webpage or open this month’s Homecare Toledo insert to learn more.