Home Health ICD-9/ICD-10 Alert

Answer: V codes are used for routine care only. Because the surgical wound is complicated, you wouldn't list the V code for surgical aftercare, says Las Vegas-based home healthcare consultant Sharon Molinari, RN, HCS-D, COS-C.

However, you can use the V codes associated with the IV because they apply to the IV, not the wound, Molinari says. To code for this patient, try listing:

• M0230a: 998.32 (Disruption of external operation wound);

• M0240b: 998.59 (Other postoperative infection);

• M0240c: 041.11 (Staphylococcus aureus);

• M0240d: V09.0 (Infection with microorganisms resistant to penicillins/MRSA);

• M0240e: V58.81 (Fitting and adjustment of vascular catheter);

• M0240f: V58.83 (Encounter for therapeutic drug monitoring); and

Other pertinent diagnoses: V58.62 (Long-term [current] use of antibiotics).

Code 998.32 (Disruption of external operation wound) is your primary diagnosis because dehiscence is assumed to be worse than the infection and should be sequenced first, Molinari says.

Under the revised prospective payment system (PPS), both 998.32 and 998.59 are among the skin conditions that earn case mix points as the primary or secondary diagnosis, Molinari says. However, you can only earn points for one diagnosis in the same category. In this case, the primary diagnosis will garner 8, 10 or 20 points depending on whether it is an early or later episode and the number of therapy visits. In addition, you'll earn 2 points if it's an early or later episode with 0-13 therapy visits and M0250 = 1 (IV/Infusion).

As for the V codes that relate to the IV, their underlying diagnosis, 041.11, is not a case mix diagnosis so you wouldn't assign anything in M0246, Molinari says.