Home Health ICD-9/ICD-10 Alert

Question: We are providing occupational therapy and physical therapy to address the patient's ataxia. She was referred to us by the hospital where she had a shunt revision. Her admitting diagnosis at the hospital was hydrocephalus. How should I code for this patient? 

Kansas Subscriber

Answer: Generally, if the patient no longer has a condition, you won't code for it. But, because hydrocephalus is a case mix diagnosis, you can still get the case mix points by using the instructions in the OASIS manual for M0245.

First, find out what caused the hydrocephalus. For example, if the hydrocephalus was part of spina bifida, you still need to code the spina bifida, 741.0x (Spina bifida; with hydrocephalus). Spina bifida is a case mix diagnosis, included on the neuro list for 20 points. Hydrocephalus in the 331.x (Other cerebral degenerations) category is also a case mix diagnosis. Code for your patient as follows:

• M0230a: V57.89 (Other specified rehabilitation procedure; multiple training or therapy);

• M0240b: 781.3 (Ataxia); and

• M0245a: 331.x or 741.xx for the hydrocephalus.

Because you are providing multiple therapies (PT and OT) for rehabilitation services, you can use the V code for admission for multiple therapies. Next, list ataxia, the residual of the hydrocephalus.

Place the hydrocephalus code in M0245 for HHRG calculation (20 points). Following the instructions for completing M0245, you should list the case mix diagnosis that is the underlying diagnosis to the V code in M0230. In this case, the hydrocephalus is the underlying condition to the admission-for-therapy V code. Because the hydrocephalus is no longer present, do not code it in M0240.

Ataxia (781.3) is also a case mix diagnosis for 11 points, but you wouldn't have coded it in M0230 before home health was permitted to use V codes. You also wouldn't list it in M0245b because the ataxia is not a manifestation of the hydrocephalus. M0245a and M0245b are only used in instances of mandatory multiple coding.