Posts tagged ‘v55’

July 27, 2011

Attack of the Vs

As usual, there are a large number of V code changes as the code year changes. A look at some that we might use …. appropriately and sparingly!

V12.5 Diseases of circulatory system: The subclassification at V12.5x now splits out venous thrombosis and pulmonary embolism. History of pulmonary embolism has its own code: V12.55.
V12.5 Diseases of circulatory system

      Excludes: history of anaphylactic shock (V13.81)
    V12.51 Venous thrombosis and embolism
      Excludes: pulmonary embolism (V12.55)
    V12.55 Pulmonary embolism

V19.1 Family history of other conditions, other eye disorders, now includes a family history of glaucoma code (V19.11)
V19 Family history of other conditions
    V19.1 Other eye disorders
      V19.11 Glaucoma
      V19.19 Other specified eye disorder

V40 Mental and behavioral problems now takes on Wandering in diseases (see the post on dementia!)
V40 Mental and behavioral problems

     V40.3 Other behavioral problems
       V40.31Wandering in diseases classified elsewhere
         Code first underlying disorder such as:
           Alzheimer’s disease (331.0)
           autism or pervasive developmental disorder (299.0-299.9)
           dementia, unspecified, with behavioral disturbance (294.21)
           intellectual disabilities (317-319)
       V40.39 Other specified behavioral problem

V54 Other orthopedic aftercare
     V54.8 Other orthopedic aftercare
       V54.82 Aftercare following explantation of joint prosthesis
           Aftercare following explantation of joint prosthesis, staged procedure
           Encounter for joint prosthesis insertion following prior explantation of joint prosthesis

V55 Attention to artificial openings: Note the new exclusions because of the new cystostomy complication codes
V55 Attention to artificial openings
Excludes: complications of external stoma (519.00-519.09, 569.60-569.69, 596.81-596.83, 997.49, 997.5)

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January 4, 2011

V58.73 is the code for cardiac catheterization with a stent

How do you code a cardiac catheterization with a stent? Aftercare? V55?

A cardiac catheterization is not considered an ostomy, so do not use V55 codes. V55 codes are not used for temporary ostomies. i.e., openings, because V55 deals with permanent placements. Use V58.73 for aftercare of the circulatory surgery. A cardiac catheterization by cut down is considered a surgical wound so mark the surgical wound questions (M1340 and M1342) appropriately for status of healing on the OASIS. A cardiac catheterization by needle puncture is not a surgical wound so make sure to mark M1350 as yes. M1350 deals with a skin lesion or open wound that excludes ostomy or other wounds addressed in the M1300s of OASIS.

The instructions at M1350 state: Ostomies, other than bowel ostomies, (e.g., tracheostomy, thoracostomy, urostomy) ARE considered to be skin lesions or open wounds if clinical interventions (e.g., cleansing, dressing changes) are being provided by the home health agency during the home health care episode.

The other items that would be excluded from M1350: Pressure Ulcers or risk of pressure ulcers (M1300, M1302, M1306, M1307. M1308, M1310, M1312, M1314, M1320, M1322, M1324), stasis ulcers (M1330, M1332, M1334), surgical wounds (M1340, M1342).

January 4, 2011

Code ostomy takedowns by disease

An ostomy takedown, where the stoma and skin opening are closed, should be coded by the original reason for the ostomy.

If the patient had colon cancer and needed a colostomy, code V58.42 for aftercare of surgery. Code the colon cancer as appropriate for an active disease or M1024 if no longer active. If the patient had a bowel obstruction or diverticulitis that resulted in the ostomy, V58.73 would be coded for aftercare. The bowel obstruction is mostly resolved so would be coded in M1024, not M1022. Diverticulitis could be resolved or still active so the choice of coding the condition in M1022 depends on whether the condition is resolved or not.

With the takedown, the opening is no longer there, so V55.3 is not a valid code. V55 codes deal with permanent ostomies!

Remember with an aftercare of surgery code that the dressing change is not part of the aftercare, so if a dressing change is part of your care,  also code V58.3x, wound dressing codes.

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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