Home Health ICD-9/ICD-10 Alert

Question: How should I code to indicate that we are providing an anticoagulant for deep vein thrombosis (DVT) prophylaxis? For example, what codes should I list for a patient who was in a motor vehicle accident and suffered multiple fractures (including the femurs of both legs) then had a DVT in the femoral vein while in the hospital? He has been placed on an anticoagulant for DVT prophylactically.

We are providing care for the multiple fractures, including nursing, therapy, pain management, teaching and assessing for the DVT. There are also orders for venipuncture to monitor the effectiveness of the anticoagulant.


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Answer: For your patient, list the following codes, says Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates in Denton, TX.

• M0230a: V54.19 (Aftercare for healing traumatic fracture of other bone);

• M0240b: V12.51 (Personal history of certain other diseases; diseases of circulatory system; venous thrombosis and embolism) or 451.11 (Phlebitis and thrombophlebitis; femoral vein [deep] [superficial]) if the condition still exists;

• M0240c: V58.83 (Encounter for therapeutic drug monitoring);

• M0240d: V58.61 (Long-term [current] use of anticoagulants); and

• M0245a: 821.00 (Fracture of other and unspecified parts of femur; shaft or unspecified part, closed; unspecified part of femur).

You can list V54.19 for aftercare, but it's better to report the separate and specific aftercare code for each fracture, Selman-Holman says.

If the physician places the patient on anticoagulants so that another thrombus doesn't develop after the first one is resolved, report V12.51 for the history of thrombosis, Selman-Holman advises. If the medical record indicates that the thrombus is still present, code it as such with 451.11, she says.

The V58.6x codes are status codes, meaning that the patient is taking the medication. Use them if the patient is expected to be on the medication long-term or is using the medication prophylactically.

Case mix tip: You can list the acute trauma fracture code in M0245 for HHRG calculation because  the V code in M0230a replaces it as a primary diagnosis, Selman-Holman reminds. The trauma fracture code isn't appropriate in M0230 or M0240 because only the initial treating facility should report this code, she says.