Home Health ICD-9/ICD-10 Alert

Question: The new coding guidelines from the Centers for Medicare & Medicaid Services and the National Center for Health Statistics specify a change involving coding for long-term (current) drug use (V58.6x). We have read that this code is appropriate for a patient who is receiving a medication for an extended period or as a prophylactic measure or as a treatment of a chronic condition, but it does not apply if the patient receives medication for a brief period of time to treat an acute illness or injury. 

I think that this "brief" period would include a six week course of antibiotics for osteomyelitis or a six week course of Coumadin after a hip replacement and the codes would not apply. However, some of my co-workers feel that these periods would constitute long-term use and we should code them as such. What do you advise?


California Subscriber

Answer: Use the V58.6x codes as secondary diagnoses only, and use them when a patient is expected to be on a medication long term or if the drug is being used prophylactically.
 
The AHA Coding Clinic has used V58.61 for a patient on Coumadin after a joint replacement. The clarification in the new coding guidelines added little to the meaning of these codes. Use the codes when it is clinically logical to do so.

While you wouldn't use V58.62 for a ten-day course of antibiotics, you might use it for a six-week course. There is no defined length of time considered "long-term" because the period is different for different medications.

Note: To request a PDF of the revised coding guidelines which became effective Dec. 1, 2005, email the editor at janm@elijournals.com.