a.d. malate, bsn,rn, rac-ct icd9 coding. a.d. malate, bsn,rn, rac-ct icd 9 cm international...

A.D. Malate, BSN,RN, RAC-CTA.D. Malate, BSN,RN, RAC-CT

ICD9 CodingICD9 Coding


ICD 9 CMICD 9 CMInternational Classification Of Diseases – Clinical ModificationInternational Classification Of Diseases – Clinical Modification

Coding Facts and TIPSCoding Facts and TIPS

Used in all clinical settings to report Used in all clinical settings to report diagnosis for CMS programsdiagnosis for CMS programs

On an Annual basis new codes are On an Annual basis new codes are published in the Federal Register for published in the Federal Register for implementation October 1implementation October 1stst of each year. of each year.

Use the ICD9 code that describes the Use the ICD9 code that describes the residents diagnosis, symptom, complaint, residents diagnosis, symptom, complaint, condition or problem. DO NOT code condition or problem. DO NOT code suspected diagnosissuspected diagnosis


Coding Facts and TIPSCoding Facts and TIPS Principal Diagnosis Code- Code must be reported

according to Official ICD-9-CM Guidelines, including proper use of V- codes (CMS Transmittal 437 for Medicare Claims Processing Manual published 1/21/2005)

Other Diagnosis Codes Required-CMS does not have additional requirements regarding reporting or sequencing of codes

Assign codes to the highest specificity. Use fourth and fifth digits where applicable

Code all documented conditions that co-exist at the time of the visit that require of affect patient care or treatment


CMS Transmittal 437

CMS Transmittal 437 for Medicare Claims Processing Manual published 1/21/2005

Principal Diagnosis Code- Code must be reported according to Official ICD-9-CM Guidelines, including proper use of V- codes

Other Diagnosis Codes Required-CMS does not have additional requirements regarding reporting or sequencing of codes

www.cms.hhs.gov/manuals/pm_trans/R437CP.pdf


Coding guidelines Coding guidelines -Long Term Care Setting --Long Term Care Setting -

The The “First listed “First listed diagnosis”diagnosis” – is the – is the condition chiefly condition chiefly responsible for the responsible for the admission to the admission to the facilityfacility

- - it is the condition chiefly it is the condition chiefly responsible for the continued responsible for the continued stay in the facilitystay in the facility

““Acute Codes”Acute Codes” – such – such as cardiovascular as cardiovascular accident (CVA) accident (CVA) myocardial infarction myocardial infarction (MI) and fractures (MI) and fractures should not be usedshould not be used

- - “late effects” codes should “late effects” codes should always be used even if the always be used even if the patient was only in the patient was only in the hospital for a short period hospital for a short period of timeof time


V CodesV Codes

Purpose Of V CodesPurpose Of V Codes – provides codes – provides codes for circumstances other than a for circumstances other than a disease or injury. V Codes are not disease or injury. V Codes are not procedure codes, but they indicate a procedure codes, but they indicate a reason for encounter or admission.reason for encounter or admission.


Primary Circumstances for the use of V Codes in Primary Circumstances for the use of V Codes in post –acute care settingspost –acute care settings

When a person When a person is not currently is not currently sick encounters sick encounters the health the health services for services for some specific some specific reasonsreasons ( e.g. organ donor, ( e.g. organ donor, inoculations, inoculations, healthcare healthcare screenings, etc. )screenings, etc. )

When a person When a person with resolving with resolving disease or disease or injury, requiring injury, requiring continuous carecontinuous care (e.g. dialysis for (e.g. dialysis for renal disease, renal disease, chemotherapy for chemotherapy for malignancy, cast malignancy, cast change, etc. )change, etc. )

When When circumstances circumstances influence a influence a persons’ health persons’ health status but are status but are not in not in themselves a themselves a current illness current illness or injuryor injury


V Codes as principal diagnosisV Codes as principal diagnosis

V Codes may be listed as a principal V Codes may be listed as a principal or secondary diagnosis as stated in or secondary diagnosis as stated in official coding guidelinesofficial coding guidelines

V Codes are used in both inpatient V Codes are used in both inpatient and outpatient settingand outpatient setting

V Codes indicate a reason for an V Codes indicate a reason for an encounterencounter


Sequencing Codes & Principal Sequencing Codes & Principal DiagnosisDiagnosis

Guidelines:Guidelines: the coder should make every effort to record the the coder should make every effort to record the codes in logical sequence that is descriptive of the codes in logical sequence that is descriptive of the patient’s conditionpatient’s condition

1.1. The underlying disease (cause ) or etiology is usually The underlying disease (cause ) or etiology is usually coded first as the principal diagnosis, followed by the coded first as the principal diagnosis, followed by the code for manifestations,. It is mandatory to follow the code for manifestations,. It is mandatory to follow the “code first”“code first” instructions on the tabular lists instructions on the tabular lists

2.2. Principal diagnosis codes – SNF enter the ICD 9-CM code Principal diagnosis codes – SNF enter the ICD 9-CM code for the principal diagnosis in FL67. The codes must be for the principal diagnosis in FL67. The codes must be reported in accordance to the ICD 9 coding guidelines as reported in accordance to the ICD 9 coding guidelines as required by HIPAA, including applicable guidelines required by HIPAA, including applicable guidelines regarding the use of VCodesregarding the use of VCodes


V Codes as first listed diagnosisV Codes as first listed diagnosis

V46.13V46.13 Encounter for Respiratory Dependence during power failureEncounter for Respiratory Dependence during power failure

V46.13V46.13 Encounter for weaning from respiratory (ventilator)Encounter for weaning from respiratory (ventilator)

V56.0V56.0 Extracorporeal DialysisExtracorporeal Dialysis

V57V57 Care Involving Rehabilitation ProceduresCare Involving Rehabilitation Procedures

V58.0V58.0 RadiotherapyRadiotherapy

V58.11V58.11 Encounter for anti-neoplastic chemotherapyEncounter for anti-neoplastic chemotherapy

V66V66 Convalescence and Palliative careConvalescence and Palliative care

V70V70 General Medical ExaminationGeneral Medical Examination

ExamplesCan only be used as a first listed diagnosis


V Codes as principal or secondary diagnosisV Codes as principal or secondary diagnosisExamples

May be used as principal or secondary diagnosis

V08V08 Asymptomatic HIV infection Asymptomatic HIV infection

V15.88V15.88 History Of fallHistory Of fall

V49.6xV49.6x Upper limb amputation statusUpper limb amputation status

V49.84V49.84 Bed Confinement statusBed Confinement status

V52 V52 Fitting and adjustment of prosthetic device or implantsFitting and adjustment of prosthetic device or implants

V54V54 Other Orthopedic AftercareOther Orthopedic Aftercare

V55V55 Attention to Artificial Openings Attention to Artificial Openings ( colostomy, urostomy,etc. )( colostomy, urostomy,etc. )

V58.4V58.4 Aftercare following surgeryAftercare following surgery

V58.7V58.7 Aftercare following surgery to specified body systemsAftercare following surgery to specified body systems


V Codes – Aftercare codes as principal V Codes – Aftercare codes as principal diagnosisdiagnosis

V58.71V58.71 Aftercare following surgeryAftercare following surgery

V57V57 Care involving the use of rehabilitation proceduresCare involving the use of rehabilitation procedures

V58.49V58.49 Other specified aftercare following surgeryOther specified aftercare following surgery

V58.83V58.83 Monitoring Therapeutic drugMonitoring Therapeutic drug

V58.89V58.89 Other specified aftercareOther specified aftercare

V57.89V57.89 Admitted for Physical and Occupational TherapyAdmitted for Physical and Occupational Therapy

V57.1V57.1 Admitted for Physical therapyAdmitted for Physical therapy

Generally used as first listed to explain the specific reason for the encounter used when the initial treatment of a disease or injury has been performed and the patient required continued care during the healing or recovery phase


V Codes – Status CodesV Codes – Status Codes as principal or as principal or secondary diagnosissecondary diagnosis

V02V02 Carrier or suspected carrier of infectious diseaseCarrier or suspected carrier of infectious disease

V09V09 Infection with drug resistant microorganismsInfection with drug resistant microorganisms

V44 V44 Artificial opening statusArtificial opening status

V45 V45 Post surgical statesPost surgical states

V49.6V49.6 Upper limb amputation statusUpper limb amputation status

V49.81V49.81 Post menopausal statusPost menopausal status

V58.6V58.6 Long Term (current ) drug useLong Term (current ) drug use

V02.61V02.61 Viral Hepatitis B carrierViral Hepatitis B carrier

ExamplesMay be used as first listed codes to explain the encounter for testing or more commonly as

a secondary to identify a potential risk


V Codes – History Codes as secondary V Codes – History Codes as secondary diagnosisdiagnosis

V10 V10 Personal history of malignant neoplasmPersonal history of malignant neoplasm

V16V16 Family history of malignant neoplasmFamily history of malignant neoplasm

V15V15 Other personal history representing hazards to healthOther personal history representing hazards to health

V15.81V15.81 History of non-compliance with medical treatmentHistory of non-compliance with medical treatment

V15.88V15.88 Frequent FallsFrequent Falls

ExamplesGenerally listed as second diagnosis


Use of Diagnosis codes with the Use of Diagnosis codes with the Minimum Date SetMinimum Date Set

Not all diagnoses reported on the MDS may be appropriate Not all diagnoses reported on the MDS may be appropriate on the UB-92 on the UB-92

For the MDS, you are selecting diagnoses and conditions For the MDS, you are selecting diagnoses and conditions relevant to a prescribed look-back period which may have relevant to a prescribed look-back period which may have been relevant at the time of MDS completion been relevant at the time of MDS completion

For the UB-92, you are selecting ICD-9 codes to support the For the UB-92, you are selecting ICD-9 codes to support the supplies and services for the dates of services being billed supplies and services for the dates of services being billed

Some time may have lapsed between the two so codes very Some time may have lapsed between the two so codes very appropriately selected for the MDS may no longer be appropriately selected for the MDS may no longer be relevant for the claim and vice versa.relevant for the claim and vice versa.

Conditions that have been resolved or no longer affect the Conditions that have been resolved or no longer affect the resident’s functioning or care plan should not be included in resident’s functioning or care plan should not be included in section Isection I

A.D. Malate, BSN,RN, RAC-CT

PRINTED IN MAY 05PRINTED IN MAY 05CHIA Journal ©CHIA Journal ©

Insights to Coding and Data QualityInsights to Coding and Data QualityCMS confirms use of V-codes on UB 92 for SNF billingCMS confirms use of V-codes on UB 92 for SNF billing

by Ann G Uniack, RHIAby Ann G Uniack, RHIA

Member, Coding and DataMember, Coding and Data Quality CommitteeQuality Committee

The Center for Medicare and Medicaid Services (CMS) has confirmed that SNFs must use the correct ICD-9-The Center for Medicare and Medicaid Services (CMS) has confirmed that SNFs must use the correct ICD-9-CM codes including V codes on the UB-92 for Medicare billing. Transmittal 437 adds the following to Pub 100-CM codes including V codes on the UB-92 for Medicare billing. Transmittal 437 adds the following to Pub 100-04 Medicare Claims Manual, Chapter 6, Section 30, Billing SNF PPS Services. The CMS online transmittal can 04 Medicare Claims Manual, Chapter 6, Section 30, Billing SNF PPS Services. The CMS online transmittal can

be accessed on the Internet at: <be accessed on the Internet at: <http://www.cms.hhs.gov/manuals/pm_trans/R437CP.pdfhttp://www.cms.hhs.gov/manuals/pm_trans/R437CP.pdf>.>.

V54V54 Other orthopedic aftercareOther orthopedic aftercareFor patients admitted to a SNF for care following treatment in the acute hospital for a traumatic For patients admitted to a SNF for care following treatment in the acute hospital for a traumatic

fracture use the aftercare codes from subcategory V54.1. “Do not code the (acute) fracture.” fracture use the aftercare codes from subcategory V54.1. “Do not code the (acute) fracture.” (CC 4th Qtr 1999 p5)(CC 4th Qtr 1999 p5)

More recently, Coding Clinic has addressed this issue in their V code article (CC 4th Qtr 2003 More recently, Coding Clinic has addressed this issue in their V code article (CC 4th Qtr 2003 p87). “There have been many questions on the use of aftercare V codes versus a diagnosis p87). “There have been many questions on the use of aftercare V codes versus a diagnosis code for fractures in the healing phase. Coding guidelines require that an aftercare code be code for fractures in the healing phase. Coding guidelines require that an aftercare code be

used for all subsequent encounters after the initial encounter for care of a fracture. For used for all subsequent encounters after the initial encounter for care of a fracture. For statistical purposes, a fracture should only be coded once. If the same fracture is coded for all statistical purposes, a fracture should only be coded once. If the same fracture is coded for all

encounters, it makes collection of fracture statistics difficult. The expansion last year (ICD-9-CM encounters, it makes collection of fracture statistics difficult. The expansion last year (ICD-9-CM 2003) of subcategory2003) of subcategory

V54.1 V54.1 Aftercare for healing traumatic fracture, was to provide more information in the Aftercare for healing traumatic fracture, was to provide more information in the aftercare code, to eliminate the need to code the (acute) fracture. The V54.1 identifies the site aftercare code, to eliminate the need to code the (acute) fracture. The V54.1 identifies the site

of the fracture and that it is in the healing phases.”of the fracture and that it is in the healing phases.”


To “V” or not to “V”To “V” or not to “V”Scenario # 1Scenario # 1

A resident is admitted for A resident is admitted for physical physical therapytherapy following a following a hip replacementhip replacement for an for an inter-trochanteric right hip inter-trochanteric right hip fracturefracture due to a due to a fall.fall.


To ‘V’ or Not to ‘V’: Scenario #1To ‘V’ or Not to ‘V’: Scenario #1 Physical therapy:Physical therapy:

V57.1 Physical TherapyV57.1 Physical Therapy

Intertrochanteric right hip fracture due to Intertrochanteric right hip fracture due to a fall:a fall:

V54.13 Aftercare following traumatic hip fractureV54.13 Aftercare following traumatic hip fracture

Hip replacementHip replacement:: V54.81 Aftercare following joint replacementV54.81 Aftercare following joint replacement V43.64 Joint replacement, hipV43.64 Joint replacement, hip


To ‘V’ or Not to ‘V’: Scenario #1To ‘V’ or Not to ‘V’: Scenario #1

Diagnosis ListDiagnosis List V57.1V57.1 V54.13V54.13 V54.81V54.81 V43.64V43.64

MDSMDS I-1m (hip fracture)I-1m (hip fracture) I-3: V54.81, V43.64I-3: V54.81, V43.64

UB-92UB-92 V57.1, V54.13, V54.81, V43.64V57.1, V54.13, V54.81, V43.64



A resident is admitted for A resident is admitted for P.T. & O.T.P.T. & O.T.following a following a hip fracturehip fracture after a fall. after a fall.The physician indicated that the fracture The physician indicated that the fracture was was due to osteoporosisdue to osteoporosis. The Discharge . The Discharge Summary stated that old Summary stated that old compression compression fractures of the vertebraefractures of the vertebrae due to due to osteoporosis were present on x-ray.osteoporosis were present on x-ray.



Physical Therapy and Occupational Physical Therapy and Occupational TherapyTherapy

V57.89 Multiple therapiesV57.89 Multiple therapies Hip Fracture (due to osteoporosis)Hip Fracture (due to osteoporosis)

V54.23 Aftercare for continuing treatment of V54.23 Aftercare for continuing treatment of healing pathologic fracture of hiphealing pathologic fracture of hip

OsteoporosisOsteoporosis 733.00 Osteoporosis733.00 Osteoporosis

Compression fractures of vertebraeCompression fractures of vertebrae 733.13 Pathologic fractures of vertebrae733.13 Pathologic fractures of vertebrae



Diagnosis List V57.89 V54.23 733.00 733.13

MDS I-1m (hip fracture); I-1p (pathological fx); I-1-o (osteoporosis) I-3: 733.13

UB-92 V57.89, V54.23, 733.00, 733.13


Resources:Resources:

www.cms.govwww.cms.gov

Internet Only ManualsInternet Only Manuals

LTC Consortium ( ICD 9 Coding )LTC Consortium ( ICD 9 Coding )

Mutual Of Omaha MedicareMutual Of Omaha Medicare

www.medicare.govwww.medicare.gov

www.aanac.orgwww.aanac.org


Questions?Questions?

a.d. malate, bsn,rn, rac-ct icd9 coding. a.d. malate, bsn,rn, rac-ct icd 9 cm international...

Documents

facilityacute codes

procedure codes

use of v codes

codes cms transmittal

principal diagnosisv

outpatient settingv

late effects codes

residents diagnosis