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V45.11 vs. V56.0

  1. Default V45.11 vs. V56.0
    Medical Coding Books
    I am wondering about the difference in these 2 codes - V45.11 - Renal dialysis status, and V56.0 - dialysis.

    When the patient comes into the office for a visit, (part of managing their dialysis, we cannot charge for this) we code 585.6 and V56.0. I am wondering if we should be using the V45.11 instead of V56.0?

    When we bill dialysis for the month, we bill with 585.6 and V56.0.

  2. #2
    Default
    If the patient is not having the dialysis performed, then you should be using V45.11 to report the status and/or presence of the AV shunt.

  3. Default
    I was thinking the same thing, even if they are on PD - the description of the V45.11 code also includes PD status as well as HD status. Thanks!

  4. #4
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    Columbia, MO
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    V56.0 is first listed only allowable and is to be used for the actual encounter to receive the dialysis. V45.11 is a secondary only code to be used to indicate the status of being a dialysis patient.

    Debra A. Mitchell, MSPH, CPC-H

  5. Default
    Yes, V56.0 is only first listed code and this is using when the patient is coming for dialysis treatment (encounter for dialysis V56.0) and the V45.11 is the status for dialysis, which means the patient has chronic kidney disease and using dialysis.

    Thara L CPC H

  6. #6
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    V56.0 excludes using the V45.11 so they cannot be coded together. It is redundant to say they are here for dialysis and they are a dialysis patient.

    Debra A. Mitchell, MSPH, CPC-H

  7. Default
    V56.0 and V45.11 are mutually exclusive, hence we can add these together? V56.0 excludes V45.11 and V45.11 excludes V56.0. (If a patient is a chronic dialysis dependent and he/she is currently coming only for dialysis, can we use both the codes together for this encounter)

    Thanks,
    Thara L CPC H

  8. #8
    Location
    Columbia, MO
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    no you cannot use them together that is the reason for the excludes note, to alert you that you do not use these two codes together.

    Debra A. Mitchell, MSPH, CPC-H

  9. Default
    If the V45.11 excludes V56.0 only, we could only assign V56.0, but here the two codes excludes each other, V56.0 excludes V45.11 and V45.11 excludes V56.0, what decision we have to take in such situation?
    ICD guidelines states "In other cases, the excluded terms may be used together with an excluded code. An example of this is when fractures of different bones are coded to different codes. Both codes may be used together if both types of fractures are present".

    Thanks for any help

    Thara L CPC H

  10. #10
    Location
    Columbia, MO
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    It is somewhat confusing which is why it is changing for ICD-10. However look at it carefully.. when you have fractures of different bones then the exclusion would not apply, but if it were fractures of the same bone then they would be excluded and you code only one. Here you have dialysis status and encounter for dialysis. they are excluded because it is redundant to say it twice, if you have an encounter for dialysis then it is obvious that the patient has the status of being a dialysis patient. this is a case where the excluded terms cannot be coded together.

    Debra A. Mitchell, MSPH, CPC-H

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