Home Health ICD-9/ICD-10 Alert

List V54.81 in M0230 because the plan of care (POC) includes proposed interventions by both disciplines and the diagnosis driving the POC is aftercare following a joint replacement, Will says. Aftercare codes describe routine follow-up care in the recovery and rehabilitation phase of a condition. In this scenario, there is no evidence of complications and the services provided are routine follow-up and postsurgical care for a hip replacement.

The Medicare Program Integrity Manual directs coders to list secondary diagnoses that best reflect the seriousness of the patient's condition and to justify the disciplines and services provided, Will says. The number and severity of secondary diagnoses affect risk adjustment for the calculation of patient outcomes, she adds.

Add to these coding requirements the ICD-9 Coding Manual, which instructs coders to list additional codes in select instances and dictates the order sequencing of certain codes. Finally, the OASIS Implementation Manual says that when a V code is the primary diagnosis and replaces a case mix code, you may complete M0245 to capture the clinical points for reimbursement.

The abnormality-of-gait diagnosis supports the need for therapy services. It's the right code to use when describing the gait impairment that results from an orthopedic surgical procedure, Will says. Although the underlying diagnosis to the V code is most likely degenerative joint disease -- which is not a case mix diagnosis -- ICD-9 coding guidelines allow you to use a symptom code when the definitive diagnosis is no longer appropriate.

Instructional notes in your ICD-9 manual under V54.81 require you to use an additional code to identify the joint replacement site, so add code V43.64 for replacement of hip joint. And the code for attention to surgical wound dressings describes one of nursing's planned skilled interventions.