Home Health & Hospice Week

V codes are just one of many sequencing concerns that could cost you precious dollars.

Coding experts agree--the trickiest thing about coding under the revised prospective payment system is sequencing. You can choose all the right ICD-9 codes, but if you don't know how to put them in the right order, you won't get the case mix points you deserve.

New payment question M0246 has six slots and "they are all potential case mix slots," says Las Vegas-based consultant and certified coder Sharon Molinari.

Hurdle: Many people are still confused by M0245, and M0246 is six times more confusing, maintains Molinari.

If you place a V code in the primary or any of the secondary diagnosis positions in M0230 and M0240--and the V code replaces a case mix diagnosis--you have an opportunity to gain case mix points for the episode.

But knowing when to report a V code and where to list it can be confusing. To help make your decision, try asking how important the V code is, suggests consultant and certified coder Judy Adams with LarsonAllen in Charlotte, NC. If the V code is important and it replaces a numerical case mix code, put it in the top six OASIS diagnosis slots, she says. If it's not as important, then code it at the bottom of the list.

Most V codes are reason for encounter codes and do not give a clue to the underlying condition, says attorney and certified coder Lisa Selman-Holman, principal of Selman-Holman & Associates in Denton, TX. It's best to list the condition codes prior to reporting V codes such as V58.31 (Encounter for change or removal of surgical wound dressing) or V58.83 (Encounter for therapeutic drug monitoring), she says.

Tip: You'll generally sequence aftercare following surgery codes such as V58.4x (Other aftercare following surgery) or V58.7x (Aftercare following surgery to specified body systems, not elsewhere classified) as primary if the patient had surgery, there are no complications and aftercare is the focus of care, says Selman-Holman.

But you should ask first if there is a complication because an acute condition trumps a V code, says Selman-Holman. Coders should also consider whether another diagnosis is really the reason for home care even though your agency is also providing aftercare.

For example: Your patient had gall bladder surgery, but while in the hospital her hypertension exacerbated and she contracted an upper respiratory infection causing her chronic bronchitis to exacerbate. While you may be providing aftercare following surgery, the aftercare is not the focus of care for this patient, says Selman-Holman. Instead, you would list:

• M0230a: 401.9 (Essential hypertension, un-specified);
• M0240b: 491.22 (Obstructive chronic bronchitis; with acute bronchitis);
• M0240c: V58.75 (Aftercare following surgery of the teeth, oral cavity, and digestive system, NEC); [...]