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Nursing Home Question -Appropriate Diagnosis

  1. Default Nursing Home Question -Appropriate Diagnosis
    Medical Coding Books
    New to Nursing home coding. What are the appropriate diagnoses? Patient is in the nursing home for status post right total knee replacement and two weeks status post displacement of her right artificial hip joint which was reduced. There are no other diagnosis. Patient does not live in Nursing home full-time just there to recover from knee replacement. I am questioning V4365 as my primary diagnosis because we have had issues with insurance paying on that as primary. This could be due to the global period of the procedure, but then I ask can we use a modifier for follow-up care only -55? Any thoughts or suggestions? Thanks for your help.

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    Quote Originally Posted by bkramer10 View Post
    New to Nursing home coding. What are the appropriate diagnoses? Patient is in the nursing home for status post right total knee replacement and two weeks status post displacement of her right artificial hip joint which was reduced. There are no other diagnosis. Patient does not live in Nursing home full-time just there to recover from knee replacement. I am questioning V4365 as my primary diagnosis because we have had issues with insurance paying on that as primary. This could be due to the global period of the procedure, but then I ask can we use a modifier for follow-up care only -55? Any thoughts or suggestions? Thanks for your help.
    V66.0 is the dx code for this scenario. It is first listed only allowed. Use the v43.65 as a secondary. The facility has no global so that does not enter into facility billing and they will not use modifiers at all.

    Debra A. Mitchell, MSPH, CPC-H

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