Home Health & Hospice Week

Home health agencies must start using V and E diagnosis codes this fall, and you'd better brush up if you don't want to risk related reimbursement and compliance disasters.

Previously, the Centers for Medicare & Medicaid Services had prohibited using V and E codes on OASIS. But now the Health Insurance Portability and Accountability Act requires their use so HHAs can come into compliance with ICD-9 coding rules.

Making the switch from avoiding V codes to using them properly is going to be a huge headache, predicts Rachel Hammon with the Texas Association for Home Care. Home care providers often have trouble sorting through coding guidelines as it is. After striving to work around V codes, it will be confusing to turn around and do just the opposite, Hammon worries.

It's essential that HHA staff responsible for coding understand that V codes represent "after-care" services following a disease or injury, explained coding expert Sue Prophet-Bowman with the American Health Information Management Association at an April 1 presentation for CMS' OASIS Coordinators Conference in New Orleans.

Agencies should use V codes to indicate specific aftercare for a resolving disease, injury or chronic condition, instructed coding veteran Prinny Rose Abraham at an April 7 presentation for the National Association for Home Care & Hospice's annual policy conference in Washington, DC. V codes also indicate special therapy, organ donors, prophylactic care and counseling, Abraham added.

Coders can still report the acute condition, if it is present, along with any V codes, Prophet-Bowman explained. But the V code should be used as the primary diagnosis only if the aftercare is the focus of care. If the agency still is treating the patient's current, acute disease or injury, that condition should be the primary diagnosis, not the V code, said Abraham.

Some V codes commonly used by home care providers will be V52.x (fitting and adjustment of prosthetic device), V55.x (attention to an artificial opening), V57.x (care involving use of rehabilitation procedures), and V66.7 (encounter for palliative care), Abraham reported.

V57.x will be especially useful in documenting a patient's need for 10 or more therapy visits, pointed out Abraham, with Minneapolis-based HIQM Consulting. Such therapy utilization increases episode payment by about $2,000 under the prospective payment system.

Using multiple V codes at once is acceptable, Prophet-Bowman detailed.

Also, using status codes, which indicate the patient has a disease, injury or condition but that it doesn't require care, is OK, but they should never be primary, Prophet-Bowman added. Categories V42 through V46 and subcategories V49.6 and V49.7 are status codes.

After Oct. 1, when agencies use V codes as a primary diagnosis and report it in OASIS item MO230, they must report any "case mix" diagnosis code in MO245 to receive their rightful payment for the patient's condition (see Eli's HCW, Vol. XII, No. 13, article "Diagnosis Coding"). A case mix diagnosis is a neurological, orthopedic, diabetic or burn/trauma code that affects PPS payment.

HHAs are likely to have a little easier time getting used to E codes, which HIPAA requires come October, experts predict. E codes classify environmental events, circumstances and conditions that caused an injury, Abraham spelled out. They also specify what caused a poisoning or adverse event, Prophet-Bowman said.

Coders should never use E codes as a primary diagnosis, explained a CMS official at the OASIS conference. Instead, the injury that was caused by the event the E code represents will be primary in those situations.

Think of it as a new skip pattern, advised Abraham. If there is a trauma code as the primary diagnosis, there should be an E code in M0240 explaining how it happened. "Trauma and E codes are companion codes," she stressed.

Common E codes include those for falls, adverse reactions to medications, late effects of external causes, complications of care and late effects of an injury, Abraham listed. Initial encounters will warrant regular E codes while late effects of an initial injury that is being treated will require late effect E codes, Prophet-Bowman explained.

One difference between E codes and other types of codes is that you don't rate their severity, noted the CMS official.