I work with a team that does medical record reviews looking for unreported diagnosis codes in relation to chronic diseases and conditions. When validated, we then report these diagnosis codes to CMS in our Risk Adjustment (RAPS) file. However, we have a few questions about when the reporting of the status V-codes for amputations and artificial openings (V44.X and V49.7X) is appropriate in relation to the RAPS submission and were wondering if anyone out there might have come across this. We have two specific examples:
1) The patient had a below the knee amputation in 1999.
The patient was seen by a physician for a routine physical in 2007.
The amputation is listed in the chronic condition list for the day of the physical, but is not specifically addressed within the body of the physical note.
Would a CMS audit allow V49.75 (lower limb amputation status- below knee) to be submitted for that date of service?
2) The patient was seen for a routine physical in 2007.
A colostomy is noted in the chronic condition list, but not address in the body of the physical note.
During the physical the physician wrote a script for colostomy supplies (the script is copied and placed in the chart)
Would a CMS audit allow V4436 (colostomy status) to be submitted for that date of service?
Any advice? Thanks!!
1) The patient had a below the knee amputation in 1999.
The patient was seen by a physician for a routine physical in 2007.
The amputation is listed in the chronic condition list for the day of the physical, but is not specifically addressed within the body of the physical note.
Would a CMS audit allow V49.75 (lower limb amputation status- below knee) to be submitted for that date of service?
2) The patient was seen for a routine physical in 2007.
A colostomy is noted in the chronic condition list, but not address in the body of the physical note.
During the physical the physician wrote a script for colostomy supplies (the script is copied and placed in the chart)
Would a CMS audit allow V4436 (colostomy status) to be submitted for that date of service?
Any advice? Thanks!!