Home Health ICD-9/ICD-10 Alert

Don't report V58.3 when a wound is complicated.

Using V58.3 (Attention to surgical dressings and sutures) as a primary diagnosis may put your wound care claims under scrutiny. To safeguard your claims, know when to use V58.3 and when to avoid it.

Regional home health intermediary Cahaba GBA announced a widespread review of claims with V58.3 as a primary diagnosis on its Web site Oct. 6. The review will focus on claims with no therapy revenue billed, a Cahaba spokesperson tells Eli. 

An increase in claims with this diagnosis sparked the review, says Cahaba. "It may not be an issue; it may be an issue. We want to take a closer look," the RHHI's spokesperson says.

Because home health agencies often provide care for patients who have had surgery, V58.3 may be a frequently used code. But this prompts coders to wonder about the close scrutiny. "Are some agencies abusing the code?" asks Vladimir Zakutinsky with Providence Home Health Care in Chicago, IL. He wonders if there is another V-code that would be safer to use instead. 

Avoid Using V58.3 For The Wrong Reasons
 
Many agencies use V58.3 for all kinds of wounds, says one expert. But you should only use V58.3 for surgical wounds.
 
Reporting V58.3 for a complicated wound is a common misuse of the code, says Dio Namocatcat with the Visiting Nurse Regional Health Care System in Brooklyn, NY. For example, when there is infection or dehiscence of a wound, use a complication code rather than a Vcode. "As a rule of thumb, the complication code trumps the V code," he says.
 
In addition, if you're using a code to indicate a complicated wound, it's assumed that some kind of wound care is being provided. Using an additional code for attention to dressings, such as V58.3, with a complicated wound is both unnecessary and incorrect.

The following examples show situations where you might be tempted to report V58.3 as the primarydiagnosis code, but because these wounds are complicated, you'll need to look elsewhere.

Example 1: Your patient has a toe amputation stump infected with staph aureus. The patient requires wound care, dressing changes, antibiotic medication and wound teaching and education. Code as follows:

M0230a: 997.62 (Amputation stump complication, infection [chronic])
 
M0240b: 041.11 (Staphylococcus aureus). 

Example 2: A patient is re-certified following an abdominal surgery that occurred two months ago. The surgical wound hasn't healed. You are re-certifying this patient for wound care. Code as follows:

M0230a: 998.83 (Other specified complications of procedures, not elsewhere classified, non-healing surgical wound).   

Example 3: The patient has a non-healing ulcer of the foot. You will be providing daily wound care and dressing changes. Code as follows:

M0230a: 707.15 (Ulcer of the lower limbs, except decubitus, ulcer of other part of foot).
   
Caution: Don't use V58.3 in cases like this, says Namocatcat. Use of V58.3 for a non-surgical wound is incorrect. "Instead, code the chronic ulcer. This will take care of the wound care," he says.

Report V58.3 As Secondary

Some experts advise never using V58.3 as the primary diagnosis. Use an aftercare code first and then report V58.3, they suggest. 

For example: Your patient had surgery for neoplasm removal. Use V58.42 (Aftercare following surgery for neoplasm) for aftercare, says Lisa Selman-Holman, JD, BSN, RN, CHCE, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates in Denton, TX. This code includes the assessment and teaching. The note at V58.4 states "Codes from this subcategory should be used in conjunction with other aftercare codes to fully identify the reason for the aftercare encounter," says Selman-Holman. You'll find a similar note at V58.7x (Aftercare following surgery to specified body systems, not elsewhere classified).
 
Once you've selected the appropriate aftercare code, add other V codes to specify the care, such as V58.3 for dressing changes, says Selman-Holman. Nurses should consider the episodic focus of care. Rarely is a dressing change the episodic focus of care, because the patient or family is taught to do the dressing change, she says. However, the nurse will still assess and teach until the wound is healed and the other aftercare is completed.

Just because the note indicates you should use other aftercare codes to fully identify the reason for the aftercare encounter, it doesn't mean that they should be sequenced together, says Selman-Holman. That's because V code sequencing is discretionary and V codes do not provide any risk adjustment for outcomes.

Know What To Do When V58.3 Is Primary

If you still believe V58.3 is the best code to describe your patient's primary diagnosis, make certain you have documentation to back up the medical necessity of your claim. You can feel secure in using V58.3 as primary if the documentation supports your claim, says the Cahaba spokesperson.
  
Example: You might report V58.3 as primary in this situation: A patient had a toe amputation due to gangrene, secondary to peripheral circulatory vascular disorder. The patient requires wound care and daily dressing changes. Namocatcat suggests coding this as follows: 

M0230a: V58.3 (Attention to surgical dressings and sutures) 
M0240b: V58.49 (Other specified aftercare following surgery) 
M0240c: 443.9 (Peripheral vascular disease, unspecified)  
M0240d: V49.72 (Lower limb amputation status, other toe[s]). 

"The patient is recovering from a disease (gangrene) that is no longer present. If your orders and assessment show that care will focus on daily dressing changes, V58.3 is your code," says Namocatcat.

Tip: You'll find the code for gangrene (785.4) in the Symptoms, Signs, and Ill-Defined Conditions chapter of your coding manual. Since it's not coded to a specific body system, gangrene isn't represented among the V58.7x (Aftercare following surgery to specified body systems, not elsewhere classified) series of aftercare codes. Instead, use V58.49 (Other specified aftercare following surgery), suggests Namocatcat.