Home Health ICD-9/ICD-10 Alert

Question: The patient is a left-handed woman who had a mastectomy for breast cancer on her right side. She has lymphedema of the right arm. She has residual weakness of her left arm due to a stroke. She takes Tamoxifen for chemo. Your agency is providing skilled nursing for wound care and supervision of exercises. This scenario was included in the Centers for Medicare & Medicaid Services' OASIS Chapter 8 Attachment D, but its code selection went against the ICD-9-CM Official Guidelines for Coding and Reporting.

Here's what CMS coded:

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

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

M0240c: 174.9 (Malignant neoplasm of female breast; unspecified);

M0240d: V86.0 (Estrogen receptor positive status [ER+]);

M0240e: 457.0 (Postmastectomy lymphedema syndrome); and

M0240f: 438.31 (Monoplegia of upper limb affecting dominant side).

How would you code for this patient?

Answer: To code correctly for this patient, you should list the following codes, says Trish Twombly, RN, BSN, HCS-D, CHCE, director of coding with Foundation Management Services in Denton, Texas:

M0230a: V58.42;

M0240b: 174.9;

M0240c: 457.0;

M0240d: 438.31;

M0240e: V07.51 (Prophylactic use of selective estrogen receptor modulators [SERMs]); and

M0240f: V58.31.

CMS's sequencing is off in this example, Twombly says. The V58.31 dressing change code isn't subject to mandatory multiple coding sequencing rules, so it can actually be listed toward the bottom, she says. Because of CMS's instructions in Attachment D for the use of M0246, the code for the underlying condition to V code V58.42, 174.9, isn't listed in M0246 because it is also listed in M0240.

CMS also jumped the gun by listing V86.0 for estrogen receptor positive status. The patient's estrogen receptor status isn't part of the scenario, so the coder doesn't have enough documentation to list this code, she says. The use of Tamoxifen is listed, so V07.51 is appropriate.