Home Health ICD-9/ICD-10 Alert

Surprise! Refills do not equal 'long term.'

Look again at long term medication use codes - you could be limiting yourself unnecessarily.

If you think V58.6 codes are too vague, you're right. But there's an important reason, one expert tells Eli.

A primary cause for many patients' admission to home care is for monitoring the effects and levels of high-risk medications. But choosing the codes for these patients has confused clinicians and coders alike.

Some situations are clear. If a patient is seen for monitoring and adjustment of his anticoagulant and has been on the medication for months, you would code V58.83 (Encounter for therapeutic drug monitoring) followed by V58.61 (Long term (current) use of anticoagulants), says Lynda Dilts-Benson, consultant with Reingruber & Co. in St. Petersburg, FL.

Problem: But questions begin when you admit a patient for monitoring of an anticoagulant she is just beginning to take, perhaps after a joint replacement or bypass surgery. Can you use V58.61 in this situation, coders ask. Is this considered "long term (current)?"

The V58.83 code indicates that a person who is on a drug for any length of time is being evaluated for the level or effectiveness of the drug. It is incomplete without also coding V58.6x to specify the type of drug, says coding expert Prinny Rose Abraham with Minneapolis-based HIQM.

But many coders also insist that comments in an issue of the American Hospital Association's Coding Clinic some years ago suggested "long term" means the patient has refills available. And this is often not the case when a home health agency admits the patient. If that is your concern, one approach is to query the physician to see if refills are available for this patient, Abraham suggests. But there's a better way.

Don't Define V58.6 Too Narrowly

Coding guidelines state the V58.6x codes "indicate a patient's continuous use of a prescribed drug (including such things as aspirin therapy) for the long-term treatment of a condition or for prophylactic use."
 
"There is no coding requirement that there has to be a refill" to use V58.6x codes, emphasizes the American Health Information Management Association's Director of Coding Policy and Compliance Sue Bowman. This code is a "judgment call," she says.

V58.6x is clearly not meant to cover a routine 10-day round of antibiotics or a one-day pre-op medication, Bowman explains. But there isn't any hard and fast rule about how many days qualify you for this code, she instructs.

"We didn't want to box people into a corner by defining what 'long term' means. No matter how many days or weeks we chose, it could exclude situations the code is really meant to cover," Bowman tells Eli. This approach requires more professional judgment but provides needed flexibility, she adds.

How do you decide? "If the medication is pertinent to the plan of care, we should use the code," maintains coding consultant Lisa Selman-Holman with Denton, TX-based Selman-Holman & Associates.

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