Home Health ICD-9/ICD-10 Alert

Question: We have a patient who had surgery for removal of a bone lesion secondary to osteomyelitis, but was referred to home health for administration of IV antibiotics. We cannot use V58.62 (Long-term [current] use of antibiotics) as the primary diagnosis because it is a secondary V code. We thought about using V58.78 (Aftercare following surgery of musculoskeletal system, NEC), and also have considered 730.2X (Unspecified osteomyelitis), which is a case mix weight diagnosis. What is the best way to code this scenario to ensure the optimal, appropriate reimbursement?

Answer: Code this scenario as follows, suggests Laresa Boyle, RHIA, director of coding services at Longview, TX-based Healthcarefirst:

M0230: V58.78 (Aftercare following surgery of the musculoskeletal system)

M0240b: V58.62 (Long term [current] use of antibiotics)

M0240c: 730.2x (Unspecified osteomyelitis)

M0245 : 730.2x (Unspecified osteomyelitis)

You may be tempted to use V58.62 as the primary diagnosis, but remember: "We are taught to use the broader V code first," notes Boyle. Further, the nurse will most likely be doing some monitoring of the wound, as well as wound care instruction, so V58.78 is the more appropriate primary diagnosis code.

Don't be fooled: In the days before home health coders could use V codes, you would have listed 730.2x as primary, Boyle points out. However, now that you can use V codes, and because the patient had the related surgery, you should list V58.78 - rather than 730.2x - as primary.

However, because the patient is on antibiotics, and is thus being treated for the osteomyelitis, you should code for it under M0240. To get the extra case mix points, you should also list 730.2x under M0245, Boyle instructs.