Home Health ICD-9/ICD-10 Alert

Question: I recently had a claim denied. Nurses, physical therapists and occupational therapists cared for a patient experiencing an exacerbation of her multiple sclerosis (MS). The nursing staff adjusted the patient's medication, occupational therapy addressed her increased muscle weakness, and physical therapy assisted her with correcting gait abnormality.

The ICD-9 codes on the claim form follow: 340 (Multiple sclerosis), V57.21 (Encounter for occupational therapy), 728.87 (Muscle weakness [generalized]), V57.1 (Other physical therapy) and 781.2 (Abnormality of gait). Am I missing something here, or should I appeal?

Answer: It looks as if you may be caught in your intermediary's education edit. The V57 category is in the primary-only list in the V code table, so your coding of the V57.1 for physical therapy and V57.21 for occupational therapy in M0240 is incorrect and drawing attention. Try removing those codes from your claim. You also need to consider whether you need both muscle weakness and abnormality of gait to support your therapies.