Home Health ICD-9/ICD-10 Alert

Published on Sat May 20, 2006 PDF

Let coding terminology guide you.

Do you know when an open wound is not an open wound? You will after you read this.

Coders and clinicians often are confused about when it's appropriate to code for an open wound and when listing an open wound could be considered upcoding. Heed our experts' advice and avoid falling into this and other common wound care coding traps.

1. Surgical wounds are not open wounds. Confusion over what constitutes an open wound for coding purposes leads to this common coding error, says Sparkle Sparks, MPT, HCS-D, COS-C, with Redmond, WA-based OASIS Answers Inc.

Clinicians often report surgical wounds that are healing by secondary intention--meaning that the patient has a gaping hole which is being allowed to close--as open wounds, says Sparks. But if you code for these wounds incorrectly as open wounds, you're risking denial, she says. 
 
Protect yourself: You could also be accused of upcoding if you list an open wound code when caring for a surgical wound, warns Lisa Selman-Holman, JD, BSN, RN, CHCE, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates in Denton, TX. An open wound in "coding language" is one caused by accident or violence, she explains.

Tip: One source that adds to the confusion over the open wound codes is the alphabetic index of the ICD-9 manual, says clinical consultant Judy Adams RN, BSN, HCS-D with Charlotte, NC-based LarsonAllen. When you look up the term "wounds" you are directed to the open wound codes, she notes. A better coding strategy is to start your search with the term for the type of wound you are reporting, such as "ulcer," she suggests.

Best bet: Report a true open wound with a code from the 870-897 categories, says Adams. List V58.43 (Aftercare following surgery for injury and trauma) if the injury has been surgically repaired, she says.

2. M0440 language is different from coding language. Still another source for confusion is that M0440 on the OASIS assessment asks "Does the patient have a skin lesion or an open wound?" points out Selman-Holman. The "open wound" in this instance is any wound, whether a "gaping hole" or an incision closed with staples, she explains. But a patient can have an open wound in M0440 without having an open wound for diagnosis coding purposes.

Reason: In coding terminology, open wounds are trauma wounds such as animal bites, avulsions, cuts, lacerations, punctures and traumatic amputations, says Adams.

Open wound example: Your patient was hit by a metal swing and suffered a deep laceration to her lower leg, which was surgically closed. She has been referred to your agency for wound care. Report the following codes for this patient, suggests Selman-Holman:

• M0230a: V58.43 (Aftercare following surgery for injury and trauma);
• M0240b: 891.0 (Open wound of knee, leg [except thigh], and ankle, without mention of complication);
• M0240c: V58.3 (Attention to surgical dressings and sutures); and
• M0245a: 891.0 (Open wound of knee, leg [except thigh], and ankle, without mention of complication).

Because you're providing aftercare following  surgery for injury and trauma, V58.43 is your primary diagnosis, explains Adams. ICD-9 instructs you to include other codes to identify the reason for the aftercare encounter, and V58.3 shows that you will be providing wound dressings.

Key: Listing 891.0 shows that you are providing care for a trauma wound and will also give you 21 case-mix points in M0245, says Selman-Holman. This raises your clinical severity score to a C2 without answering any of the other clinical domain questions, she notes.  

Note: For a detailed discussion of wound issues, order the tape or CD of Adams' teleconference "Prevent Wound Care Down-coding and Denials in Home Health" at http://codinginstitute.com/conference/tapes.cgi.