Don't list V57 as secondary.
If you're wondering whether you can use V57.x for patients that receive therapy and other discipline visits, you'll have to wonder a while longer.
The Centers for Medicare & Medicaid Services has issued new guidance on diagnosis coding in light of the V code changes that took effect Dec. 1, 2005. Coding guidelines changed so that some V codes, including the popular V57.x (Care involving use of rehabilitation procedures), can be listed as a primary diagnosis only (see Eli's HCW, Vol. XIV, No. 45).
CMS reminds home health agencies to check out the new primary diagnosis-only requirements. HHAs shouldn't have to change much--they should choose their primary and secondary diagnoses as they always have, except to avoid those primary diagnosis-only V codes as secondary diagnoses, CMS says.
Agencies should use V codes "when a person with current or resolving disease or injury encounters the health care system for specific aftercare of that disease or injury," CMS adds. Don't use V codes when specific codes for medical or surgical complications would work better, CMS cautions in the guidance at
www.cms.hhs.gov/HomeHealthPPS/downloads/v_code_rev_stmt2.pdf.
The National Association for Home Care & Hospice is disappointed that CMS' guidance doesn't contain one major clarification--whether V57 is appropriate only for cases with therapy visits and no nursing or other discipline visits. "Some coding experts took the position that because of the December changes, home health providers are limited to using V57 codes ... in therapy-only cases," NAHC notes. • CMS is asking physicians and treating practitioners to hold certain power wheelchair or scooter claims until April 1.
The Medicare Modernization Act of 2003 requires docs to submit parts of the medical record along with the wheelchair or scooter prescription to durable medical equipment suppliers, CMS explains in a fact sheet at
www.cms.hhs.gov/apps/media/press/release.asp?Counter=1780.
Physicians will receive a separate payment of $21.60, billable with code G0372 (Physician service required to establish and document the need for a power mobility device), in addition to the payment for the office visit to recognize the additional work involved.
CMS implemented these changes through an interim final rule, effective in October 2005, but Congress has directed Medicare to wait until April 1 to implement the rule.
Physicians can (1) continue to submit the G0372 code and evaluation and management (E/M) on the same claim. Carriers will hold payment for these claims until after April 1; (2) hold all claims containing the G0372 code until after April 1; or (3) submit the E/M service now and bill the G0372 code after April 1. Carriers will pay the E/M service now and the G0372 code after April 1.
After April 1, docs must bill the E/M and G0372 code on the same claim, CMS says. [...]
