# V codes-should you start



## grandmacora (Jan 26, 2010)

When should you start using v codes for fractures?  Should the aftercare codes be used durring the global time with the code for the fx, of do i just use the v code? Thanks


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## jlmjem (Jan 26, 2010)

We use the V codes only during the global period if nothing else is done (ie, a new cast applied or x-rays taken). Then we use the V code on the post op visit, but the fracture code on the cast application or x-ray.  And always remember to use modifier 58 on your cast application within the global period.


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## mitchellde (Jan 26, 2010)

You use the V code after initial treatment.  So once the reduction has occurred then it is a V code for healing traumatic fx.  You do not use an acute fx code for any follow up visits casr changes or x rays... per coding clinic 3rd quarter 2001


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## Networker3412 (Jun 10, 2011)

so even if the xray does not show healing fracture you should still use the aftercare codes and not the acute codes? i am a little confused. the order with say f/u fracture but no healing fracture on the xray fracture not healed or in the healing phase, still shows fracture not aligned etc??


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## mitchellde (Jun 11, 2011)

if it is non healing or malaligned then use the codes for that, otherwise it is healing.  It is no longer acute once it has been treated.  Remember this is the patient's diagnosis and the physician's.  The patient has been treated for only one acute fracture not several.


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## Networker3412 (Jun 11, 2011)

the argument that we are having in my office is that for example the patient was seen in er had fracture and splint applied and the next day sees the ortho dr one coder says that the ortho dr visit should always be aftercare no matter when they pt was initial treated and no matter if it is in the healing process or not. I coded an account where the order says f/u fracture and the xray shows not healing, no alignment still shows fracture even after several days and weeks go back and i am being told that i coded this wrong because it is not acute anymore even though it is not healing yet all because these are follow up visits with the ortho dr. how do you know that it is not still in the active phase vs aftercare if the xray shows no alignment, and fracture is still there? did i go the account wrong and i should have used the aftercare code even thought it was not healing just because pt saw ortho dr?


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## mitchellde (Jun 11, 2011)

Ok when a patient is seen in the ER for a fracture we have to ascertain if the treatment applied was to treat the fracture or was it to afford comfort to the patient and to reduce the swelling until an ortho could see the patient and perform definitive fracture care.  Unless it is a simple nondisplaced fracture this is usually the case, in which case the ortho still sees an acute fracture as the fracture has not yet been treated.  However after fracture treatment then it can no longer be a fracture from the definition of an acute fracture which is an acute injury that has not been treated.  After treatment, if the xray states that the fracture is malaligned or there is no no bone healing as of yet then you should query the provider as to whether this is a nonhealing fracture, because at this point the choice of acute fracture is off the table, it is healed, healing, non-healed, or malaligned, all of these have unique diagnosis codes without giving the patient the status of incurring a new fracture.


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## Networker3412 (Jun 11, 2011)

thankyou for the clarification i was trying to get our other coder to understand that just because the patient sees an ortho dr does not mean that it is always the aftercare code. thank you i will forward this information on my department whether they listen is another storyl


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## Networker3412 (Jun 13, 2011)

ok so is this aftercare just so I am understanding.

order states " rt knee patella fracture" ordered by the ortho dr. 

xray says" AP and lateral of her right knee shows that there has not been any displacement of the comminuted fracture of patella."

I have no idea if this fracture was treated etc. This is all I have. 

ACute or aftercare?? 

Thanks


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## mitchellde (Jun 13, 2011)

If it is a comminuted fx then it would have been treated with some type of fixation such as a plate or pins and these would have or should have been mentioned in the impression so I am leaning toward acute fx.


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