Home Health ICD-9/ICD-10 Alert

Question: Our patient was admitted to the hospital for acute appendicitis. He had an appendectomy and has returned home. We will be providing wound care and assessment of the incision site. Nursing will change the dressing three times a week. Nursing will also teach the family to change the dressing every other day and which symptoms to report. The patient will continue on his medication for hypertension and atrial fibrillation with labs every month. How should we code for him?

— Vermont Subscriber

Answer: In this case, the focus of your care is aftercare following the patient’s surgery, says Joan L. Usher, BS, RHIA, COS-C, ACE, with JLU Health Record Systems in Pembroke, Mass. Code for this patient as follows:

• M1020a V58.75 (Aftercare following surgery of the teeth, oral cavity and digestive system);
• M1022b 401.9 (Essential hypertension; unspecified);
• M1022c 427.31 (Atrial fibrillation); and
• M1022d V58.83 (Encounter for therapeutic drug monitoring).
• M1022e V58.31 (Encounter for change or removal of surgical wound dressing)

You are doing more than simply changing this patient’s dressings, so listing an aftercare code as primary is appropriate.

Previously, you would have listed 540.9 (Acute appendicitis; without mention of peritonitis) in M1024 across from V58.75 to indicate the resolved underlying reason for the surgery (appendicitis). But under 2013 HHPPS you can no longer include codes for conditions resolved by the surgery. CMS rationale for the change is that the episode will receive case mix points based on: active comorbidities, clinical status M questions such as surgical wound in M1342, and any functional impairments such as M1820 — Dressing Lower Body or M1830 — Bathing.

Your comorbidities for this patient include atrial fibrillation and hypertension. Plus you’ll want to list the V codes for dressing changes and therapeutic drug monitoring. The aftercare following surgery code does not include the dressing changes so it’s appropriate to include the V code for dressing changes. Remember that the sequencing of additional V codes is discretionary so you can drop them to the bottom of your list.