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V54.89 vs. V67.09 vs.V58.78


Best answers
When a pt comes in for post op visit that is not fracture care or joint replacements, what is the best diagnosis code to use for correct coding purposes. I know that the visit is global and not billable but just looking for advice that if it was what would be the appropriate code to use. For ex. a post op from carpal tunnel, which dx code would be better suited? I've been instructed that if in global use V54.89, out of global use V67.09. Just curious!


Lubbock, TX
Best answers
V67.09, I believe.

Aftercare codes are for when the patient has already had a procedure done, but still requires ongoing care during the recovery phase, OR care to treat the long-term consequences of the disease. (*Patient still healing - like when they have bone-fixation devices put on, for example).

Follow-Up codes (like V67.09) are for after the treatment has been completed, and the problem no longer exists, but the patient still needs to have continued surveillance. (*Patient has healed).

V54.89 is for fracture care NOS, so you can rule that one out, and V58.78 is for the musculoskeletal system. (Carpal Tunnel is reported with a code from the nervous system section, so if it really is aftercare, the correct code would be V58.72). There are whole paragraphs in the ICD-9's coding conventions on the difference between follow-up and aftercare, in case I didn't explain it well... :)