Home Health ICD-9/ICD-10 Alert

Get ready to add another layer to dressing codes.

You won't have to wait any longer for more specific codes to describe attention to dressings: ICD-9 2007 expands the V58.3x (Attention to dressings and sutures) subcategory with three new codes. And coders frustrated by the lack of codes to report mucositis will discover expanded codes for this condition as well.

Heads up: The V58.3 category expansion means you'll need to differentiate between the type of wound (surgical or nonsurgical) and the type of attention you'll provide (change/removal of dressings or removal of sutures).

Code V58.3 has often been used incorrectly for nonsurgical wound care, says Judy Adams, RN, BSN, HCS-D, with Charlotte, N.C.-based LarsonAllen. ICD-9 2007 expands the subcategory to three five-digit codes, which enables coders to indicate different types of wound care, she says.

"In home care, we often provide dressing changes for non-surgical wounds. Now we have a code to show what we're doing for these wounds," says Lynn Yetman, RN, MA, HCS-D, COS-C, LNC, with Reingruber & Company, St. Petersburg, FL.

The new codes are:

• V58.30 (Encounter for change or removal of nonsurgical wound dressing);

• V58.31 (Encounter for change or removal of surgical wound dressing); and

• V58.32 (Encounter for removal of sutures).

Note These Dressing Details

The catch: You should use V codes to report resolving conditions. Prior to these new codes, you could only report V58.3 when caring for surgical wounds that were resolving and not complicated. Following the same V code guidelines for V58.30 means you should not use this code for wounds that are acute, chronic or otherwise not resolving. That doesn't leave many other kinds of wounds, so this code's usefulness may be limited.

Don't overlook: Other changes to this subcategory include added inclusion and exclusion terms. An added inclusion term indicates that you may use codes from this subcategory to report "change or removal of wound packing." New exclusion terms advise you not to use V58.3 codes for "attention to drains" or "planned postoperative wound closure." Also note that code V58.32 can be used to report staple removal, as well as sutures.

Gain Details With Mucositis Codes

Until this year's ICD-9 update, if you were providing care for patients going through chemotherapy, you had no good way to code for mucositis.

Mucositis is a frequent complication of cancer treatment, including radiation and chemotherapy. Ulcerative sores in mucosal surfaces throughout the body can occur from these cancer therapies. Because the treatments affect fast growing cells, they affect the mucosal cells as well as the cancer cells.

Good news: Previously, your only option to code these painful sores was to report them as an ulcer by site. Now you have new, more specific options for coding these sores.

You can specifically identify ulcerative mucositis by using a fifth digit of "1" with the 478.1x series (Other diseases of nasal cavity and sinuses). For example, code 478.11 indicates "Nasal mucositis (ulcerative)." The "other specified code" 478.1 will become 478.19 (Other disease of nasal cavity and sinuses).

And code 528.00 (Stomatitis and mucositis, unspecified) for the oral mucosa breaks out into four codes, including two for mucositis due to antineoplastic therapy (528.01) and due to other drugs (528.02). These codes both require you to also list an E code to indicate the drug causing the problem.

Additional codes are available for the bowel (gastrointestinal -- 538) and the mucosa of the cervix, vagina and vulva (616.81).