Home Health ICD-9/ICD-10 Alert

Don't report a V code when specific complication codes are available.

Still uncertain you've nailed down when to report codes from the V57.x category? You're not alone--The National Association for Home Care & Hospice has questions too.

The Centers for Medicare & Medicaid Services has issued new guidance on diagnosis coding in light of the V code changes that took effect Dec. 1, 2005. The coding guidelines have changed so that some V codes, including V57.x (Care involving use of rehabilitation procedures), can be listed only as the primary diagnosis.

CMS reminds home health agencies to check out the new primary diagnosis-only requirements. HHAs shouldn't have to change much--they should choose their primary and secondary diagnoses as they always have, except to avoid those primary diagnosis-only V codes as secondary diagnoses, CMS says.

Determining when rehabilitative therapy should be the primary diagnosis still depends on the individual patient circumstances, says Sue Bowman, RHIA, CCS with the American Health Information Management Association in Chicago. Sometimes it requires a judgment call, she says. But if rehabilitative therapy isn't the primary diagnosis, V57 should not be reported as a secondary diagnosis, she instructs.

Best practice: Agencies should use V codes "when a person with a current or resolving disease or injury encounters the health care system for specific aftercare of that disease or injury," CMS adds. Don't use V codes when specific codes for medical or surgical complications would work better, CMS cautions in the guidance.

The National Association for Home Care & Hospice is disappointed that CMS' guidance doesn't contain one major clarification--hether V57 is appropriate just for cases that have therapy visits only and no nursing or other discipline visits. "Some coding experts took the position that because of the December changes, home health providers are limited to using V57 codes ... in therapy-only cases," NAHC notes.

Note: To receive a PDF of the CMS guidance, email the editor at janm@elijournals.com.