Posts tagged ‘438’

December 5, 2010

CVA, V12.54 and Hemiplegia

There seem to be some lingering questions from guidance of a few months ago. This issue is one that never seems to  go away: CVA.In the past, the Coding Clinic had instructed hospitals not to code hemiplegia in acute CVA patients if the hemiplegia had resolved before discharge. (Q2, 1989) A question in the Q2 2009 Coding Clinic asked for reconsideration of this policy, given the significance of the diagnosis and the fact that many patients may be receiving therapy, even though the diagnosis is resolved.

This should not affect home health coding, given we cannot use acute codes in M1020 or M1022. We use late effects. Three codes deal with hemiplegia …

438.20, Hemiplegia affecting unspecified side
438.21, Hemiplegia affecting dominant side
438.22, Hemiplegia affecting nondominant side
We should be able to continue to code these for our therapy patients.

This change should not affect V12.54, history of TIA/CVA. Since all the deficits are resolved before our patients get to us, there are no late effects to deal with. We can still code acute stroke in M1010 and M1016 provided within 14 days.

September 4, 2010

Watch diagnosis codes that exclude each other

Here is another question I recently received:

Question: We are having an audit, and the surveyors indicated the primary diagnosis is not supported by the secondary diagnoses: 781.2, 781.3, 728.87, V15.88, 438.84, 386.54

That the status post head injury from 20 years ago is important to the patient’s condition and abilities. We have argued this information is included in the comments, but did not see the need to code here.

This is the admission information included: 22 y/o female referred to therapy d/t decline in function and recent falls. Hx includes head trauma since age of 2 w/weakness/hypertonicity right side of body. Has had PT & OT since 2 years old. Lives w/parents, PLOF independent w/all transfers and ambulates w/o assistive device. She presents w/generalized weakness, ataxic gait & requires SBA w/transfers for safety.

Father refuses other therapy at this time.

Lisa says: This is a late effect of head injury, which means you code the residual deficits (conditions produced) first, followed by the late effects code. It appears that the patient has hemiplegia as a result of a head injury (described as weakness/hypertonicity right side of body). In addition, abnormality of gait (781.2) and ataxia (781.3) exclude each other, so they would not be coded together, nor would they be coded with hemiplegia.

Weakness and ataxia are part of the hemiplegia and would not be coded in addition. 438 is a late effects of CVA code, and the patient doesn’t appear to have had a CVA. (It is, unfortunately, common for coders to automatically think of the 438 series when coding hemiplegia, but remember that ONLY deals hemiplegia with stroke. Go to the 342 series for other hemiplegia.)

I would code this patient with 342.1x (fifth-digit decided by whether this is affecting dominant or non-dominant side), 907.0, V15.88.

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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