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Aftercare/follow ups

  1. #1
    Cool Aftercare/follow ups
    Medical Coding Books
    If a patient comes in for aftercare of an injury (laceration, etc.), what icd-9 codes would you use? Do you use a v-code, with the injury code, (i.e., V58.89 W/ 879.8 & E928.9) or just the v-code? Currently all follow up and aftercare codes are being denied by MCD. Would it be appropriate to use just the injury codes? I'm wary about using just the injury code since it's not current.
    Likewise, how would you code a resolved illness if that was the only dx given? Guidelines direct to use a follow up code when a condition is resolved, but Again, follow up codes are being denied by MCD.
    Any suggestion?

  2. #2
    Location
    Columbia, MO
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    12,943
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    You never code the acute injury code with the follow up or after care. Perhaps the reason for a denial is global. Medicare as with other payers should pay for any non global follow up encounters the V code is sufficient for coding. It is the patient's dx we are coding and if the condition no longer exists then we cannot say that it does. So what we need to know is what does the denial reason state.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Houston, Texas
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    24
    Default I agree with Debra.
    No matter what, you can't code acute condition when it is a follow-up.

  4. #4
    Default
    They get denied for age restriction.

    Im more concerned with the aftercare codes then the follow up codes. Medicaid denies them, however I dont find it appropriate to code an injury after care as if its just happened. Especially as these are IHS facilities, and the E-codes is required, so any injury code looks like its just happened. I dont want to make the argument the aftercare code is the only one available when I get the argument back that the condition still exsists. (ie pt comes in for aftercare of a laceration, abrasion, contusion etc... The condition still exsists, however its not new, and v58.30 doesnt apply since most often then not a wound dressing isn't done)

  5. #5
    Location
    Columbia, MO
    Posts
    12,943
    Default
    If a pt comes for aftercare of a laceration it is not still present you have a repaired laceration, but not an acute one, an acute laceration by definiton is a jagged open wound. Contusions may still be present, abrasions may still be present but be certain from the documentation or are they now "healing nicely" which says they are no long acute. You can always use aftercare codes with the code that describes the type of aftercare being delivered such as dressing changes, suture removal, attention to drains, etc. So while the condition may be present, it is there in a treated or healing form not acute. Medicaid should not be denying the V codes for aftercare if you are out of a global. You need to see what your Medicaid regs state.

    Debra A. Mitchell, MSPH, CPC-H

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