Some V Codes You Should Know About But not necessarily use SAMPLE. Lisa Selman Holman JD, BSN, RN, HCS D, COS C

Transcription

1 Some V Codes You Should Know About But not necessarily use Lisa Selman Holman JD, BSN, RN, HCS D, COS C For the exclusive use of HCIN subscribers 1

2 Download Handouts If you have not already downloaded handouts for this seminar: Click on details or links to access seminar handouts. Select collateral material or handouts to open a pdf. Save the pdf and print. Overuse (voluminous) V code crazy Inappropriate use (vexing) Using when condition is complicated Sequencing issues Inadequate risk adjustment and case mix weights (vile) Risk adjustment no risk adjustment on V codes Case mix weights (2008) use too many V codes? Sequence them differently? You may be sequencing diagnosis codes that are case mix out of M0240. (c)selman Holman & Associates Objectives Used when a condition code doesn t apply Many are reason for encounter codes The most common type of V code we will use is the aftercare following surgery codes. Coding Wounds Ostomies 2 3 Objective: Discuss those V codes you may need to use in home care coding 4

3 If aftercare is the focus of care, then sequence the aftercare code first. If not the focus of care, consider whether you need to code the V code for aftercare at all. If complicated, do not code. If routine aftercare, is it primary focus or secondary? Code the V codes that don t have to be primary at the bottom. What about the severity? Patient has an infection of his tracheostomy with cellulitis. V code for attention to trach? (c)selman Holman & Associates Potential Hazard/Communicable Diseases V04.81 Flu vaccine V09 Resistance to antibiotics V09 Post surgical wound with MRSA; con t to receive IV atb therapy Staph aureus (resistant) infection of surgical wound M Post op infection M Staph aureus M0240 V09.0 Resistance to penicillins M0240 V58.81 Fitting and adj of vascular device M0240 V58.62 LT use antibiotics 5 6 7

4 Potential Health Hazards related to Personal History Explain a patient s past medical condition that has the potential for recurrence and, therefore, may require continued monitoring. Home care only personal history History Codes V10 History of malignant neoplasm V12.51 History of Pulmonary Embolism V12.42 Personal history of infection CNS V12.61 Personal history of pneumonia V13.02 Personal history UTI V15.88 History of falls (P or S) V12.53 history of sudden cardiac death V12.54 history of CVA/TIA without residuals Is the history really important and does it require monitoring because it may reoccur? Status Codes Persons with a Condition Influencing Health Status V40 49 Status Codes Sequelae or residual of past disease or condition Informative If using the code indicates a condition that affects the course of treatment, then code it. Secondary only (with a few exceptions)

5 Use of Status Codes Categories V42 46 and subcategories V49.6, V49.7 are for use ONLY if there are no complications or malfunctions of the organ or tissue replaced, the amputation site or the equipment on which the patient is dependent. Unless the book instructs you otherwise don t use a status code when there is a complication Organ/Tissue Replacement V42.x V42 Organs replaced by transplant V42.0 Kidney V42.1 Heart V42.2 Heart valve V42.6 Lung M0230 V58.44 Aftercare surgery transplant M0240 V42.7 Liver Organ/Tissue Replacement V43.x V43 Organs replaced by other means V43.2 Heart V43.3 Heart valve V43.4 Blood vessel V43.6 Joint *** V43.64 Hip V43.65 Knee V43.81 Larynx

6 Other Postprocedural States V45 V45.01 Pacemaker status V45.02 Implanted defibrillator V45.1 Dialysis status V45.3 intestinal bypass or anastomosis Remember that these are not procedure codes. They would usually be listed following the AC codes. Other Post procedural States V45 V45.81 Aortocoronary bypass status V45.82 Angioplasty status Usually coded after V58.73 for postsurgical status Most V48 49s can be redundant Exceptions are: V49.6x upper extremity amputation status (P or S) V49.7x lower extremity amputation status (P or S) Can be a new amputation or a longstanding amputation AS LONG AS NOT COMPLICATED V48 V49 V49.83 awaiting transplant status V49.84 Bed confinement status (P or S) 16

7 Aftercare V Codes Aftercare Codes V50 59 Initial treatment of a disease or injury has been performed and the patient requires continued care during the healing or recovery phase or for the long term consequences of the disease Primary or secondary unless otherwise noted V53 Fitting and Adjustment of Other Device V53.31 reprogramming of pacemaker V53.6 urinary device Excludes ostomies (V55.5 cystostomy) If a patient has a suprapubic catheter, code V55.5, attention to cystostomy, NOT V53.6 for the fitting and adjustment of an urinary catheter Routine continuing care of a catheter vs. care of the condition itself or a complication Patient requires foley catheter change for urinary retention Patient requires teaching of new med, assessment of effectiveness and foley catheter maintenance for BPH Patient has catheter and UTI 19

8 Answers Patient requires foley catheter change for urinary retention V53.6 and urinary retention Patient requires teaching of new med, assessment of effectiveness and foley catheter maintenance for BPH BPH and V53.6 as a reason for encounter code at the bottom Patient has catheter and UTI , UTI and NO V53.6 V57 the most common V code and our favorite V57 is like Heinz 57 steak sauce. A little is good but too much takes the taste away. Aftercare Therapy V57.x Use additional code to identify underlying condition Primary only V57.1 Physical therapy (therapeutic and remedial exercises) V57.21 Occupational therapy V57.3 Speech therapy V57.81 Gait training in the use of artificial limbs V57.89 Multiple training or therapy

9 Use V57 codes only if the case is therapy only. If the condition that therapy is treating is primary, then it will be in M0230(a) or M0246(a). One exception do you really want to know?? The Myth Whoever has the most frequency gets to be primary (THIS IS FALSE) The Truth If therapy is the ONLY service provided, then code first. If the patient is NOT being admitted solely for therapy, do not use the V57 code at all. If two equal primary reasons for care THE POINT do not use a V code if you don t have to. M0230/M0240 V57.1 PT abn of gait V54.81 aftercare joint replacement V43.65 joint replaced M DJD or trauma fx DJD or trauma fx 25

10 M0230/M0240 V54.81 Aftercare joint replacement M0240 V43.65 joint replaced M abn of gait M0240 V58.83 encounter for monitoring of meds M0240 V58.61 LT use anticoagulants M0246 DJD DJD How many points? How important are comorbidities? The patient was just released from the hospital after a two day stay for CHF. He has several new meds, etc. Therapy wants 3w4 then re evaluate for 3w2 for muscle weakness. Nursing frontloads and wants a frequency of 3w2 then 1w6. What is the primary diagnosis? Therapy and nursing will provide services related to Multiple Sclerosis with therapy having the most frequency. What is the primary diagnosis?

11 The patient has had an exacerbation of her COPD with new meds, oxygen and nebulizer treatments. Nursing for O and A and teaching. She had a stroke two years ago and her dysphagia has increased causing some difficulty with aspiration. Speech therapy will be visiting 2w4. Primary diagnosis or ? The V57.3 code wouldn t be used at all. V58.3 Attention to Dressings and Sutures (includes wound packing) V58.30 Encounter for change or removal of nonsurgical wound dressing Encounter for change or removal of wound dressing NOS V58.31 Encounter for change or removal of surgical wound dressing V58.32 Encounter for removal of sutures Encounter for removal of staples V58.3 Attention to Dressings and Sutures Use as primary only if the sole reason for care is a dressing change Code it at the bottom if you insist on using it

12 Complicated Surgical Wound Code surgical wound complications as wound complications non healing surgical wound post operative infection dehiscence disruption of internal operation wound dehiscence disruption of external operation wound Physician documentation required 996.xx complications of surgeries 997.xx complications of surgeries Aftercare Long term (current) Drug Use (secondary only) V58.61 Anticoagulants V58.62 Antibiotics V58.63 Antithrombotics/Antiplatelets V58.64 Steroids V58.65 Non steroidal anti inflammatories V58.66 Aspirin V58.67 Insulin V58.69 Other medications LT Use Long term not defined Do you expect that the patient will be on the medication for a time? Or is the patient on the drug for prophylactic purposes? Use the code when it is clinically logical to do so. Don t use for filling med boxes or medication management or for every med the patient is on

13 Aftercare Specific Procedures V58.81 Fitting and adjustment vascular catheter V58.82 Fitting and adjustment non vascular catheter V58.83 Encounter for therapeutic drug monitoring Use with additional code for any assoc long term (current) drug use V58.61 V58.69 Assessment and venipuncture V Code Application V58.81 Patient with urinary catheter is getting IV antibiotics for an acute bladder infection caused by E coli. M Infection due to indwelling urinary catheter M Acute cystitis M E coli M0240 V58.81 fitting and adj vasc cath M0240 V58.62 use of antibiotics V Code Application V58.81 Patient has a staph aureus infection of the central line site that will be treated with IV antibiotics M Infection due to central line M Staph aureus M0240 V58.62 Use of antibiotics Patient needs central line flushed TKO for periodic chemo M0230 V