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Status V codes and CMS Medicare Risk Adjustment

  1. Default Status V codes and CMS Medicare Risk Adjustment
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    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!!

  2. #2
    Default
    I would imagine
    1) V49.75 would be a secondary dx
    2) V44.3 would be a secondary dx

    Quote Originally Posted by MHalagan View Post
    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!!
    Rachele Porter, AS, CPC, CPC-H, CEDC
    no weapons formed against me shall prosper

  3. Default
    I just ran across this question. I would say no! CMS has clearly stated that the problem list cannot be used for capturing chronic conditions unless it is incorporated into the not and a updated status of the condition is documented. I would use the charts you are seeing for examples to carry out education for the providers. Also on the amputation status, you may want to look in the actual physical exam to see if the provider documents such things as BKA, no clubbing no cynosis, healed well, etc. Then it is being addressed within the body of the note and can be captured. hope this helps

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