Home Health ICD-9/ICD-10 Alert

Question: We have a patient coming home after suffering several falls and sustaining bilateral subdural hematomas for which she had an evacuation. She has vertigo, atrial fibrillation, and hypertension. She is ordered SN and PT. How do I code this patient?

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

M0230: V58.43 (Aftercare following surgery for injury and trauma, NOS)

M0240: 780.4 (Dizziness and giddiness; vertigo)

            427.31 (Atrial fibrillation)

            401.9 (Essential hypertension; unspecified)

            V57.1 (Other physical therapy)

             E888.9 (Unspecified fall)

M0245: 852.20 (Subdural hematoma without mention of loss of consciousness or open wound)

Because the hematoma was evacuated the patient no longer has it, but you can still place the code for the hematoma in M0245 for 20 case mix points. Before home health coders were able to use V-codes, you would have had to code the hematoma in M0230.

In this case the V code V58.43 replaces the case mix diagnosis 852.20. Note that even though this code technically is a trauma wound code, only 20 points are available because it appears on the neuro list, not the trauma wound list, notes Lisa Selman-Holman, JD, BSN, RN, CHCE, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates in Denton, Texas.

Now that home care can use V codes, you still want the increased reimbursement you would have gotten before, so Medicare allows you to code the hematoma in M0245.

Remember: The code(s) you place in M0245 do not appear on the claim or the plan of care so diagnoses for conditions that no longer exist may still be coded in M0245.

Note on specificity: The place of the falls is not specified, so use an optional E888.9. If you can learn more about the falls, you should use a more specific code.
The same goes for the hypertension code: If you can determine whether the hypertension is malignant or benign, you should use the appropriate, more specific code.

Don't be fooled: You might be tempted to use V58.72 (Aftercare following surgery of the nervous system, NEC) or even V58.73 (Aftercare following surgery of the circulatory system, the code normally used for a CVA resulting from a bleed, NEC) instead of V58.43. However, you should stick with V58.43 because the patient is receiving aftercare of a traumatic injury, which covers conditions classifiable to 800-999. Code V58.72, on the other hand, is for conditions classifiable to 320-359 and V58.73 is for conditions classifiable to 390-459.