Home Health & Hospice Week

Warning: Don't confuse 'status' and 'attention to' V codes.

Home health coders and V codes have a complicated history. There was a time when these codes were off-limits in home care. And since that ban was lifted, the Centers for Medicare & Medicaid Services has warned against over-using these codes.

Make sure you're using V codes accurately and effectively with these tips from the experts.

Take A Closer Look At These V Code Categories

V codes report a variety of circumstances that affect a patient's condition. They can report different types of aftercare and therapy, a status important to the patient's health, a health condition you will be providing attention to, and relevant past medical history.

(For in-depth articles on aftercare and therapy V codes, see Eli's Home Health ICD-9 Alert Vol. 9, No. 5 and Vol. 9, No. 6.)

Report 'Just The Facts' With Status V Codes

Status V codes explain a current medical condition that is not receiving any treatment, but has the potential to affect the patient's plan of care and therefore may require continued monitoring, says coding expert Trish Twombly, director of coding with Foundation Management Services in Denton, Texas.

You'll find the status V codes in the V40-V49 range with some in the V80 category due to lack of room. These codes describe a previous surgery or injury that may influence your care, Twombly says. Usually the condition has no significance for the episode of care so these codes are not often listed as principal diagnoses.

New in ICD-9 2012, status V code V40.31 -- Wandering is diseases classified elsewhere has been helpful when coding for Alzheimer's patients who wander.

Other status V codes frequently seen in home health include those in the V44.x -- Artificial opening status category. These codes indicate your patient has the following artificial openings:

• V44.0 -- Tracheostomy
• V44.1 -- Gastrostomy
• V44.2 -- Ileostomy
• V44.3 -- Colostomy
• V44.5 -- Cystostomy

Listing one of these codes indicates that your patient has an artificial opening that does not require care from the agency, but that could potentially impact the care you provide.

Status codes in the V45.x (Other postprocedural states) category are also useful in home health. These include:

• V45.01 -- Cardiac pacemaker in situ
• V45.02 -- Implanted defibrillator
• V45.11 -- Renal dialysis status
• V45.81 -- Post-surgical aortocoronary bypass surgery
• V45.82 -- Angioplasty status
• V45.86 -- Bariatric surgery status

Caution: Don't confuse these cardiac device status codes with the V53.3 -- Fitting and adjustment of cardiac device V codes, Twombly cautions. The V45.x codes indicate status only, while the V53.x codes report reprogramming or other active care.

Other status V codes common in home health include:

• V46.2 -- Dependence on supplemental oxygen
• V46.3 -- Wheelchair dependence
• V49.6x -- Upper limb amputation status
• V49.7x -- Lower limb amputation status
• V49.83 -- Awaiting organ transplant status
• V49.84 -- Bed confinement status
• V49.85 -- Dual sensory impairment
• V49.86 -- Do not resuscitate status
• V49.87 -- Physical restraints status

Caution: New in 2011, V49.87 can be used when it is documented by the provider that a patient has been put in restraints during the current encounter. However, this code isn't appropriate for home health patients who are temporarily restrained during a procedure, Twombly says.

Describe Care With 'Attention To' V Codes

"Attention to" V codes describe a current medical condition that is receiving treatment and is affecting the plan of care, Twombly says.

It's only appropriate to list one of these codes when you'll be providing care related to the condition or its sequelae, Twombly says. Examples include the V53.x -- Fitting and adjustment of other devices codes and the V55.x -- Attention to artificial openings codes.

List these codes to indicate that the device or artificial opening requires care such as teaching, feeding, or cleansing, Twombly says.

Don't miss: Three V55.x codes earn case mix points, so it's even more important to make certain you are listing them appropriately. These revenue-earners are V55.0 -- Attention to tracheostomy, V55.5 -- Attention to cystostomy, and V55.6 -- Attention to other artificial opening of urinary tract.

Note: For more information on assigning diagnosis codes accurately and obtaining your rightful reimbursement, subscribe to Eli's Home Health ICD-9 Alert at www.elihealthcare.com.