New guidelines warn against coding complications "just because." The 2012 update marked the last hurrah for new ICD-9 codes as the transition to ICD-10 ramps up. Changes for fiscal year 2013 are expected to be minimal (emergency updates only), but changes for 2012 have been plentiful. Make sure you're on top of the changes you should know to properly complete M1020/M1022. Learn these New Bladder Disorders Codes Four new codes for other disorders of the bladder include specific complication codes for cystostomies and are likely to be used in home health. Look for 596.81 (
Note:
The V codes for routine care of the cystostomies and urostomies are case mix, but CMS did not provide case mix status to the complication codes.Take Note of Complications Changes
Several new and more specific complication codes may be useful in home health, particularly as inpatient diagnoses in M1010, says
Judy Adams, RN, BSN, HCS-D, COS-C with Adams Home Care Consulting in Chapel Hill, N.C. These include:New codes 999.32 and 999.33 improve upon old code 999.31 (
Infection due to central venous catheter) by allowing you to specify whether the infection is of the bloodstream or local, says Jennifer Warfield, BSN, HCS-D, COS-C, education director with PPS Plus Software in Biloxi, Miss.Update:
Changes to the official coding guidelines warn against coding complications "just because," says Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates and CoDR -- Coding Done Right in Denton, Texas. Choose the codes based on the documented relationship between the condition and the care or procedure your agency is providing.This complications guideline extends to
any complications of care, regardless of which chapter includes the corresponding code, Selman-Holman says. But not all conditions that occur during or following medical care or surgery are classified as complications. The documentation must show a cause-and-effect relationship between the care provided and the condition, and it must indicate that the condition is a complication.Bottom line:
Request clarification, if the complication is not clearly documented, the guidelines advise.Know These New V Codes
V code changes most likely to impact home health include:
V codes V54.82 and V88.2x help to clarify when reporting aftercare for patients who have had their hip prostheses removed, says
Therese Rode, RHIT, HCS-D, senior coding manager with Inova VNA Home Health in Falls Church, Va. Previously, the closest you could come to describing these patient's aftercare needs and non-ambulatory status were V58.43 (Aftercare following surgery for injury and trauma) and V46.3 (Wheelchair dependence). The new combination does a better job of describing these patients, Rode says.Take note:
None of the V code changes are case mix, however CMS added V54.82 to the list of eligible V codes opening use of diagnosis code payment item M1024, Selman-Holman says. But the underlying diagnoses to V54.82, complications of joint replacements, are not case mix.Also of interest to home health agencies are:
For a more detailed look at all the new 2012 ICD-9 codes, see Eli's Home Health ICD-9 Alert. Information on subscribing is online at www.elihealthcare.com.