Home Health ICD-9/ICD-10 Alert

Question:

Since 782.4 (Jaundice, unspecified, not of newborn) does not fall within the code range for any of the V58.7x aftercare codes, I would normally default to V58.49 (Other specified aftercare following surgery). But V58.49 is not to be used for "routine drain care," and according to my ICD-9 manual, the same goes for V58.82 (Fitting and adjustment of nonvascular catheter).

I would use V58.75 (Aftercare following surgery of the teeth, oral cavity and digestive system, NEC) if I knew the patient had a digestive disorder, or V58.42 (Aftercare following surgery for neoplasm) if it was certain the drains were placed due to cancer. But for this patient, I truly have no idea what code to use.

Massachusetts Subscriber

Use V58.49 or V58.75 for aftercare in this case.

You don't have confirmation of the neoplasm, so it's not appropriate to use V58.42 for this patient.

In other situations, the AHA's Coding Clinic for ICD-9-CM has used an aftercare following surgery code that didn't necessarily fit neatly into the "codes classifiable to" range in the accompanying note.

For example: The Coding Clinic indicated that the correct aftercare code for gastric band surgery is V58.75. The usual reason for such surgery is obesity, which like the hyperbilirubinemia code, doesn't fit neatly into any of the aftercare following surgery codes.

Choice #1: The code V58.49 includes changing or removing surgical drains. Routine care of surgical drains is covered under the aftercare following surgery codes. In this case, however, the V58.49 code is the correct aftercare code because 782.4 does not fit in any other aftercare following surgery category. A letter from the Coding Clinic indicates that this is the correct code for aftercare following surgery for gangrene, coded 785.4. Like hyperbilirubinemia, gangrene doesn't fit into any of the other aftercare following surgery subcategories.

Choice #2: Hyperbilirubinemia is usually indicative of a digestive system disorder, such as a liver disorder of some kind. Because the liver is part of the digestive system, V58.75 is a good choice.