Home Health ICD-9/ICD-10 Alert

Huber Needle Coding Explained
 

Question: How would you code the discontinuance of a Huber needle for a person who came home from the hospital and was admitted to home care? One of the orders is to discontinue the chemo.

Answer: This would be covered by V58.81  (Fitting and adjustment of vascular catheter, removal or replacement of catheter), Dilts-Benson says.
 
A Huber needle is inserted into a port, which is implanted under the skin. The port allows access to the patient's vascular system for PRN access. Because the port is subcutaneous, it allows the patient the freedom to shower and swim, etc., without having to worry about the venous access device in between treatments, when the Huber needle is not in place.

Question: If you want to include a symptom code for "altered mental status," would you use 780.99 or 780.09? Could you please explain why?

Answer: If you look for altered mental status in the Index to Diseases found in your coding manual, it sends you to 780.99 (Other general symptoms). This is the code to use in the absence of any other data. It is a very general code to be used when the condition is NEC (not elsewhere classified), Dilts-Benson explains

Code 780.09 (Alteration of consciousness, other) references specific mental changes (levels of consciousness) or symptoms (drowsiness, semi-coma, somnolence, stupor, unconsciousness).
 
Even though the Index to Diseases points you to 780.99, if you know what the exact symptoms are, and the symptoms match the description in 780.09, then that is the code to use. Otherwise, in the absence of any other information regarding a disease process, condition or exact symptoms, you would code 780.99, Dilts-Benson adds.

Question: I'm confused about when you should use the different codes for insulin pumps. If a patient has had an insulin pump for some time, would we code both V45.85 and V58.69 for the medication itself? Or is it understood that if you have an insulin pump, the insulin is part of the pump code?

Answer: You would use V45.85 (Other postprocedural status, insulin pump status), which covers the pump, since it requires filling on a periodic schedule and continues to need someone to monitor it to ensure it is still functioning well.

In addition, you would now use V58.67 (Long term (current) use of insulin) - not V58.69 (Long term (current) use of other medication), which you would have used before October 2004 - because you will still be monitoring side effects of insulin.

Reader questions were reviewed by Lynda Dilts-Benson, RN, CCM, CRRN, CRNAC, LHRM, HCS-D, a consultant with Reingruber & Co. in St. Petersburg, FL.