f/u hips and knees

jaldrich

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My ortho physician (I'm in a multispecialty clinic and my providers keep me guessing) is seeing patients s/p 1 year follow up hip or knee arthroplasty. Patients are doing fine. He's billing an E/M code and the primary dx is V43.6_ (based on whether hip or knee) A lot of these patients are Medicare which does not like the Vcode and as far as I can tell that code is indicated to be a secondary dx only. The secondary code he's giving is the arthritis that prompted surgery usually 715.15 or 715.16 however, pt is no longer complaining of that problem. Dictations usually look like this:

"Patient is doing fine. Her x-rays of her right total hip arthroplasty look excellent with very nice placing of the components without evidence of loosening. Her date of surgery was 09/19/07. She is ambulating without assistive devices, still performing her hip exercises. She is very pleased with the outcome. I will plan to recheck her in three months again, with an x-ray check of the right hip. "

Suggestions on how I should code this? Am I incorrect that V43.6_ is indicated in the ICD-9 book that it's a secondary code?

Any and all help is appreciated.
Thanks,
Jen
 
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225
Location
Modesto, CA; Central Valley Chapter
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It looks like to me that you should be using an othopedic after code code such as V54.81 (after care after joint replacement) then the V43.6x code to indicate which joint it was. I would not use the osteoarthrosis dx as since the joint has been replaced it is no longer an issue.

We have not had any problems using the V54 after care codes with medicare in this area.

Hope this helps

Tina
 
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