Home Health ICD-9/ICD-10 Alert

Question: In your January issue, you gave a coding scenario in which V49.72 (Lower limb amputation status; other toe[s]) was listed for M0240e. I thought it was only appropriate to list this code in the primary or secondary position. Isn't it wrong to include it so far down the list?

Massachusetts Subscriber

Answer: This is a common misunderstanding. In coding, "secondary" doesn't mean "second"; it means "other than primary." In other words, there are no tertiary or quaternary codes. A code that may be secondary only means the code may be listed in any of the M0240 data items.

However, there are certain codes, called manifestation codes, that require sequencing in a certain order. For example, if a manifestation code is the focus of your care, you must code for it in the first secondary position preceded by its underlying condition.

For instance, if the focus of your care is the arthritis caused by Lyme disease, you must code Lyme disease first (088.81) followed by 711.81 (Arthropathy associated with other infectious and parasitic diseases; shoulder region). The arthropathy code provides 11 points, but only if it is in the first secondary position.