My new codes webinar is Fridat Aug. 19 (TODAY!) at noon central time!
Learn everything you need to know about new codes and guidelines effective Oct. 1.
http://selmanholmanblog.com/2011/08/04/new-codes-seminar/#entry
August 4, 2011
New codes seminar!
My new codes seminar is rapidly approaching … come listen Aug. 19, 1-2:30pm CDT for a few highlights of the nearly 200 new and changed diagnosis codes for 2012 including:
• Expanded codes for E coli from one to 4 new codes.
• 40 new skin cancer codes that will add both case mix and non-routine supply points.
• New probably case mix codes for dementia without a specific underlying etiology will allow recognition of the presence or absence of behavioral issues and a change to what is described as a behavioral issue.
• Changes to the V code for history of pulmonary embolism.
• New complication codes associated with gastric band surgery, cystostomies and stem cell transplants.
• Specific V codes for acquired absence of joints when a prosthetic joint has been removed and replaced with a spacer.
March 27, 2011
Coding Clinic tackles HTN and renal sclerosis coding
These Q&As come from the Coding Clinic, Fourth Quarter 2010 Page: 137 Coding advice or code assignments contained in this issue effective with discharges October 1, 2010.
Question:
A patient seen in the physician’s office was diagnosed with renal sclerosis due to hypertension. I understand that this should be coded with a code from category 403, Hypertensive chronic kidney disease, but I’m unable to determine what 5th digit should be applied. Please provide some clarification.
Answer:
Assign code 403.90, Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified. The fifth digit of “0″ should be assigned since there is no chronic kidney disease stage specified. In addition, assign also code 587, Renal sclerosis, unspecified.
Question:
A patient with renal sclerosis due to hypertension and stage V chronic kidney disease (CKD) is seen in the doctor’s office. How should this be coded?
Answer:
Assign code Assign code 403.91, Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease; code 587, Renal sclerosis, unspecified; and code 585.5, Chronic kidney disease, stage V, for a patient with hypertension due to renal sclerosis and stage V CKD. The fifth digit for subcategory 403.9 is selected on the basis of the documented CKD stage.
© Copyright 1984-2010, American Hospital Association (“AHA”), Chicago, Illinois. Reproduced with permission. No portion of this publication may be copied without the express, written consent of AHA.
October 29, 2010
V53.99 is not a wound VAC code
A treat today … no tricks. Another clarification on wound VAC coding …
I’ve posted several pressure ulcer/wound VAC answers lately (look in the archives of this blog, or click on the keywords at the bottom of this post!) Here’s another one that I hope gets us to better coding:
Question: May we use the aftercare code of V53.99 to capture the use of the VAC?
Lisa says: V53.99 is fitting and adjustment of other device and is very non-specific. There is no specific code for wound VACs. Also consider that most wounds that require a wound VAC are complicated wounds, so what does that mean about using a V code?
You DON’T use V codes for complicated codes.
The wound VAC is simply a wound dressing, so IF a V code is appropriate, use V58.30 or V58.31. If the wound is complicated, then just code the wound. I do not recommend the use of V53.99 for wound vacs.
September 7, 2010
The straight guidance on M1024
I receive many, many questions on M1024, OASIS’s payment question. I recently had this one:
Question: I am trying to get some clarification on when to fill in M1024 if a V code is used in place of a case mix. It was my understanding that you would fill in M1024 if a V code was used in the primary spot for an acute or resolved condition or a DM, Neuro or Skin 1 code. You would not fill in M1024 for a V code in the primary spot if the condition was still active and going to be listed in the secondary spots, other than the DM, Neuro or Skin 1 code.
Also what about V codes in the secondary spots, do we need to fill in M1024?
Lisa says: Remember that M1024 was created as a payment slot for when V codes replace diagnosis codes. This way, the patient’s condition is fully represented. M1020 and M1022 deal with active diagnoses. M1024 is mainly for resolved diagnoses, but CMS has made a few exceptions to this general rule.
The OASIS manual offers a lot of guidance on when to use M1024, and it boils down to these situations:
• When a V code replaces a resolved case mix condition that is the reason the V code is placed in M1020 or M1022.
• When a V code replaces a fracture. Fractures are acute diagnoses, so they are not allowed in M1020 and M1022, per official coding guidelines. We can place them in M1024.
• Use M1024 when a V code in M1020 replaces a diagnosis from the Diabetes, Skin 1 and Neuro 1 case mix categories, regardless of active or resolved status. These three case mix categories are the only ones that receive different case mix points based on whether they are coded primary or secondary. CMS has allowed coding of active conditions in M1024 in these very specific conditions. Still code these three categories in M1022 when active.
If a diagnosis code is active, and therefore eligible for coding in M1022, it cannot be listed in any M1024 slot, with the exception of the three categories listed above.
Yes, you should fill out M1024 in secondary slots, as long as the etiology is for a different underlying, resolved condition than a diagnosis listed in another M1024 slot. For example, if resolved breast cancer is the reason for V codes in M1020 and M1022, don’t put 174.9, the breast cancer code, in both M1024 slots. You have already represented the disease in the M1024 slot across from M1020. Don’t put it across from an M1022 slot, as well. If you code multiple V codes and each has a different etiology, certainly list each across from the appropriate V code. Only case mix codes are eligible for M1024, but there is more than case mix at play: risk adjustment can also be recognized in M1024 slot.
Remember: Only case mix codes are eligible for M1024.
Keep in mind this compliance issue: All M1024 and resolved conditions must be on the plan of care, even though M1024 is not part of the claim. There is no “official” or “right” place to put these conditions, but Locator 21 is an often-used documentation spot.
August 18, 2010
2011 Guidelines Clarify V07, ‘With’ and some CVA
2011 Coding Guidelines have been updated, and there are very few additions to the Guidelines. I am still scanning for any deletions (which are not noted by CMS). Here, first, are some additions to watch:
In the Conventions section, there is a clarification of “with” when used in the Tabular List and Index. With “should be interpreted to mean ‘associated with’ or
‘due to.’”
There are two notes at CVA. Neither applies to home health, but I’ll write about them because CVA is such a watched (and miscoded) diagnosis.
One note at CVA talks about coding neurologic deficits regardless of whether they resolve prior to discharge. Remember that this applies to acute discharge, not home health.
The second note states that 438 codes are for late effects of cerebrovascular disease (which we know, because we use this code category, note 434), not for neurologic deficits associated with an acute CVA. This simply confirms that 438 codes are for post-acute settings, such as home health. There are no code change implications for home health, and this guidance goes along with 3rd Quarter 2009 Coding Clinic guidance where even resolved deficits are code in acute settings, even if resolved at discharge.
V codes always have changes, and there is a general clarification of what Status codes are, with new guidelines stating that these are …. codes that show a patient is a carrier of a disease, has the sequelae or residual or has another factor influencing health.
Following the changes to the Tabular List, the guidelines now indicate that V07 is appropriate for prophylactic or treatment measures.
Those are the main additions … I’ll post more if there are other changes or deletions I find out about.
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June 22, 2010
Assessment and the correct choice of V44 or V55
I recently received a great question: When your clinician is assessing a tracheostomy and ordering supplies, but the patient cares for the trach, which code is used?
As anyone who has heard me teach on V codes knows, there is a pretty easy line to draw between coding a V44 and a V55 code, but this has an interesting twist.
V44 codes are status codes, so you use them just to report the presence of a trach tube or another artificial opening. There is no clinical care involved, so you also code V44 when a patient is caring for the opening independently or with a caregiver’s help.
V55 codes are considered aftercare codes, according to the official coding guidelines, and are used when there is clinical intervention and care, such as cleaning or overall care.
Back to the question I received: We don’t have official guidance on this, but I would code the V55 code (V55.0, Attention to Tracheostomy) because only a nurse can assess the trach for infection or other issues.
Important Note: The official coding guidelines specifically say that V44 and V55 codes should not be coded together.
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May 26, 2010
New Codes Are Officially Out
The 2011 code changes are officially here!
The CDC and NCHS released all of the changes … additions, subtractions, definitions and wording adjustments … earlier today. After a link problem (you couldn’t get to the changes! you can now access changes.
The link incorrectly states that Errata has been posted, but it’s the Addenda for 2011.
Take a peek, and come back here for analysis …
Scroll down to the bottom for the addenda.
May 19, 2010
Coding and OASIS puzzle quiz!
Sometimes we need to think through some of the tasks we do over and over … what do they mean? This OASIS and coding quiz gives you a chance to think and solve a puzzle!
April 26, 2010
2011 code changes are here
The release of new, revised and deleted codes for 2011 reflects the recent trend of fewer code changes, and with many of the changes reflecting more specificity rather than new diagnosis additions.
More specific codes deal with blood diseases and iron, fecal issues, such as smearing and incontinence, and more than 60 new V codes, many focusing on personal history, BMI, and codes that reflect inuries due to warfare, such as foreign objects left in the body.
Go to the Inpatient Prospective Payment System p. 1044 to see the code changes that go into effect Oct. 1.
