OASIS Alert

Published on Fri Mar 26, 2004 PDF

Don't throw away money when using these codes.

V codes, E codes, primary diagnoses, symptom codes -- will it ever end? If diagnosis coding is getting you down, focus on one small piece at a time.

Coding aftercare for fractures has been the biggest change for agencies now learning to use V codes, according to coding expert Prinny Rose Abraham with HIQM Consulting in Minneapolis. This is because they "bump up against case mix codes -- the injury codes for trauma," she told listeners in a March 5 teleconference sponsored by Eli.

Before October 2003, when V codes weren't allowed on OASIS forms, the only way clinicians could code a fracture was to use one of the acute fracture codes. And the Centers for Medicare & Medicaid Services based the case mix payment structure on the home health coding system without V codes. So the trauma case mix codes add dollars to the episode payment for home health under the prospective payment system.

Official coding guidelines -- now required by the Health Insurance Portability and Accountability Act -- limit the use of acute fracture codes to the initial encounter for treatment, Abraham instructed. And home health is rarely involved in providing initial treatment for a fracture.

Learn these commonly used codes: Home health usually is involved when the patient needs care after the fracture is treated. That's when orthopedic aftercare codes such as V54.1 (Aftercare for healing traumatic fracture) would be used, Abraham said. Other codes that might replace fracture case mix codes are V54.2 (Aftercare for healing pathological fracture) or V57.1 (Physical therapy).

But because an aftercare for fracture code now replaces a case mix code in M0230, the case mix code must go in M0245 to capture the extra payment, she explained. If you fail to put it there, you will be throwing money away.

Exception: One time you would use an injury code rather than an aftercare code in M0230 or M0240 would be when the patient has a sprain rather than a fracture, Abraham said. Here the acute condition still exists, she explained. It was not resolved by surgery.