Home Health ICD-9/ICD-10 Alert

Unless otherwise indicated, reader questions were answered by Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates in Denton, TX.

Question: I read that overuse of V codes may sabotage my payment under the 2008 prospective payment system. I like to use V codes to "tell the story" and to show that we are providing medically necessary care. I've been told that I should put V codes at the bottom of the list unless the V code indicates the focus of care. Please explain why using the V codes is bad and what about sequencing in order of severity?

-- Florida Subscriber

Answer: While "telling the story" is important, it is true that overuse of V codes is sabotaging your risk adjustment on your outcomes now and will sabotage your payment under the new PPS in 2008.

The Centers for Medicare & Medicaid Ser-vices calculates risk adjustment based on the diagnoses listed in M0230, all the M0240s and M0245. V codes do not provide any risk adjustment. When you use too many V codes, you are failing to include the numeric diagnoses that would have been placed in those data items and would have provided risk adjustment.

Don't overlook: Under the 2008 PPS, payment will be available for the diagnoses listed as primary as well as the co-morbidities listed in the M0240s and M0246. (CMS has substituted M0246 for the M0245 item we currently use.) M0246 will help in the problem of overused V codes but will not completely resolve it.

Important: There are three V codes that will create case mix points under the new system -- V55.0 (Attention to tracheostomy), V55.5 (Attention to urostomy/cystostomy) and V55.6 (Attention to other artificial openings of urinary tract).

Bottom line: If a V code has to be primary because the V code represents the focus of care, then place it primary. Otherwise sequence the V codes at the bottom of the list (with the exceptions of V55.0, V55.5 and V55.6). There is no requirement for sequencing in order of severity. That instruction does not appear in any CMS documents. And remember that V codes are not the same as procedure codes.