Archive for October, 2010

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.

October 29, 2010

Look beyond payment with M1016 and ROC

I wanted to clarify the use of M1016 when you’re changing diagnosis codes at a resumption of care. In this circumstance, would you change the codes in M1016 at recertification or just keep an eye on it?

Part of the answer is looking at when you use OASIS slots with the ROC.

Diagnosis codes at the ROC are placed in M1010, M1016 and M1020/1022/1024 as appropriate.

The other part of the answer lies in looking at the overall impact your ROC may have, not just the payment impact.

Although coding at ROC does not impact your payment (except if the ROC is performed in the last 5 days of the episode) it does impact you risk adjustment on your outcomes.

Because of that impact, it is important to update your codes as necessary at ROC.

October 27, 2010

836 codes are case-mix

I’ve received some queries in the past few days wondering if the 836 codes are case-mix. They are! Your books are right!

All 836 diagnoses are Ortho 1 case-mix, and that’s confirmed in the Grouper software for FY2011.

October 26, 2010

Wound VAC doesn’t apply because a wound is healing slowly

I’m thinking of creating a pressure ulcer page on the blog … I get so many questions on these wounds! At the end of this post, you’ll see some key words in green … if you want to find all posts that deal with stage II pressure ulcers, click on that link and you will have the archive!

Question: We have a patient being recertified. She has a stage II pressure ulcer and has been coded as such up to now. There is a discussion as to how to appropriately code with the placement of a wound VAC. Some are saying to code 891.1, complicated open wound, to account for the VAC. I’m thinking that I will continue to code the pressure ulcer to the ankle with a code for the stage. There is no documentation of the wound being infected, it’s just slow to heal and is now being treated with the VAC. I didn’t think there was a code we could use to capture the VAC.

Any advice?

Lisa says: You are correct! The wound is still a pressure ulcer, and there is no code for wound VAC. Coding the wound with an 800 code is incorrect and is considered upcoding. The nature of a pressure ulcer is chronic. The 800 codes are used for trauma wounds.

October 24, 2010

Attend the HHQI Coaching Webinar!

Selman-Holman Associates is a LANE, and we wanted you to know that the HHQI National Campaign on education … this one on coaching and care transitions … is Nov. 12, and the spots are filling fast! See below, the and attached flyer, for more information.

Implementing the Coaching Model, Nov. 12, 1pm EST

Who Should Attend: Home Health Quality Improvement National Campaign participants and supporters, including home health executives, medical directors, therapists, medical social workers, home health aides, skilled nursing and hospital stakeholders; Quality Improvement Organizations (QIOs)

Goals:

  • Discuss a real-world case study of how home health is making Care Transitions a reality
  • Share best practices on developing and launching a home health-based Care Transitions Initiative
  • Highlight the patient touch points, benefits and outcomes from a home health-based Care Transitions program.

HHQI_CoachRegisFlyer_final