Home Health ICD-9/ICD-10 Alert

Question: Our patient had surgery for colon cancer. We are providing wound care and colostomy care. The patient will continue to have treatment for colon cancer, has metastasis to the liver, and also has dehydration and hypertension. How should we code for him? 

New Jersey Subscriber

Answer: Code for this patient as follows, says Lynn Yetman, RN, MA, HCS-D, COS-C, LNC, with Reingruber & Company, St. Petersburg, FL.

• M0230a: V58.42 (Aftercare following surgery for neoplasm);

• M0240b: V58.31 (Encounter for change or removal of surgical wound dressing);

• M0240c: V55.3 (Attention to artificial openings, colostomy);

• M0240d: 154.0 (Malignant neoplasm of rectum, rectosigmoid junction, and anus, rectosigmoid junction);

• M0240e: 197.7 (Secondary malignant neoplasm of respiratory and digestive systems, liver, specified as secondary); and

• M0240f: 401.9 (Essential hypertension, unspecified).

Your focus of care is aftercare for this patient's cancer surgery, so this is your primary diagnosis. Additional V codes help describe the skilled care you will be providing to dressings and the colostomy.

Because the colon cancer is still being treated, list it next. If the surgery had been successful in eliminating this cancer, you would list V10.05 (Personal history of malignant neoplasm; gastrointestinal tract).

The record indicates that the cancer has metastasized to the liver, and you know that this is a secondary site, so it's appropriate to list the secondary neoplasm code.

Check to be certain that the dehydration is a current condition, says Yetman. If this diagnosis came from the hospital, it may already be cleared up. List 276.51 (Dehydration) only if you're currently treating the dehydration.

Tip: For added risk adjustment for other co-morbidities, use the V58.42 as primary and sequence the other V codes at the bottom of the list.