1. A.D. Malate, BSN,RN, RAC-CT ICD9 Coding

2. A.D. Malate, BSN,RN, RAC-CT ICD 9 CM International Classification Of Diseases – Clinical Modification Coding Facts and TIPS  Used in all clinical settings to report diagnosis for CMS programs  On an Annual basis new codes are published in the Federal Register for implementation October 1 st of each year.  Use the ICD9 code that describes the residents diagnosis, symptom, complaint, condition or problem. DO NOT code suspected diagnosis

3. A.D. Malate, BSN,RN, RAC-CT Coding Facts and TIPS   Principal Diagnosis Code- Code must be reported according to Official ICD-9-CM Guidelines, including proper use of V- codes (CMS Transmittal 437 for Medicare Claims Processing Manual published 1/21/2005)   Other Diagnosis Codes Required-CMS does not have additional requirements regarding reporting or sequencing of codes   Assign codes to the highest specificity. Use fourth and fifth digits where applicable   Code all documented conditions that co-exist at the time of the visit that require of affect patient care or treatment

4. A.D. Malate, BSN,RN, RAC-CT CMS Transmittal 437 CMS Transmittal 437 for Medicare Claims Processing Manual published 1/21/2005   Principal Diagnosis Code- Code must be reported according to Official ICD-9-CM Guidelines, including proper use of V- codes   Other Diagnosis Codes Required-CMS does not have additional requirements regarding reporting or sequencing of codes www.cms.hhs.gov/manuals/pm_trans/R437 CP.pdf

5. A.D. Malate, BSN,RN, RAC-CT Coding guidelines -Long Term Care Setting -  The “First listed diagnosis” – is the condition chiefly responsible for the admission to the facility - it is the condition chiefly responsible for the continued stay in the facility - it is the condition chiefly responsible for the continued stay in the facility  “Acute Codes” – such as cardiovascular accident (CVA) myocardial infarction (MI) and fractures should not be used - “late effects” codes should always be used even if the patient was only in the hospital for a short period of time - “late effects” codes should always be used even if the patient was only in the hospital for a short period of time

6. A.D. Malate, BSN,RN, RAC-CT V Codes  Purpose Of V Codes – provides codes for circumstances other than a disease or injury. V Codes are not procedure codes, but they indicate a reason for encounter or admission.

7. A.D. Malate, BSN,RN, RAC-CT Primary Circumstances for the use of V Codes in post –acute care settings When a person is not currently sick encounters the health services for some specific reasons ( e.g. organ donor, inoculations, healthcare screenings, etc. ) When a person with resolving disease or injury, requiring continuous care (e.g. dialysis for renal disease, chemotherapy for malignancy, cast change, etc. ) When circumstances influence a persons’ health status but are not in themselves a current illness or injury

8. A.D. Malate, BSN,RN, RAC-CT V Codes as principal diagnosis  V Codes may be listed as a principal or secondary diagnosis as stated in official coding guidelines  V Codes are used in both inpatient and outpatient setting  V Codes indicate a reason for an encounter

9. A.D. Malate, BSN,RN, RAC-CT Sequencing Codes & Principal Diagnosis Guidelines: the coder should make every effort to record the codes in logical sequence that is descriptive of the patient’s condition 1. The underlying disease (cause ) or etiology is usually coded first as the principal diagnosis, followed by the code for manifestations,. It is mandatory to follow the “code first” instructions on the tabular lists 2. Principal diagnosis codes – SNF enter the ICD 9-CM code for the principal diagnosis in FL67. The codes must be reported in accordance to the ICD 9 coding guidelines as required by HIPAA, including applicable guidelines regarding the use of VCodes

10. A.D. Malate, BSN,RN, RAC-CT V Codes as first listed diagnosis V46.13 Encounter for Respiratory Dependence during power failure V46.13 Encounter for weaning from respiratory (ventilator) V56.0 Extracorporeal Dialysis V57 Care Involving Rehabilitation Procedures V58.0Radiotherapy V58.11 Encounter for anti-neoplastic chemotherapy V66 Convalescence and Palliative care V70 General Medical Examination Examples Can only be used as a first listed diagnosis

11. A.D. Malate, BSN,RN, RAC-CT V Codes as principal or secondary diagnosis Examples May be used as principal or secondary diagnosis V08 Asymptomatic HIV infection V15.88 History Of fall V49.6x Upper limb amputation status V49.84 Bed Confinement status V52 Fitting and adjustment of prosthetic device or implants V54 Other Orthopedic Aftercare V55 Attention to Artificial Openings ( colostomy, urostomy,etc. ) V58.4 Aftercare following surgery V58.7 Aftercare following surgery to specified body systems

12. A.D. Malate, BSN,RN, RAC-CT V Codes – Aftercare codes as principal diagnosis V58.71 Aftercare following surgery V57 Care involving the use of rehabilitation procedures V58.49 Other specified aftercare following surgery V58.83 Monitoring Therapeutic drug V58.89 Other specified aftercare V57.89 Admitted for Physical and Occupational Therapy V57.1 Admitted for Physical therapy Generally used as first listed to explain the specific reason for the encounter used when the initial treatment of a disease or injury has been performed and the patient required continued care during the healing or recovery phase

13. A.D. Malate, BSN,RN, RAC-CT V Codes – Status Codes as principal or secondary diagnosis V02 Carrier or suspected carrier of infectious disease V09 Infection with drug resistant microorganisms V44 Artificial opening status V45 Post surgical states V49.6 Upper limb amputation status V49.81 Post menopausal status V58.6 Long Term (current ) drug use V02.61 Viral Hepatitis B carrier Examples May be used as first listed codes to explain the encounter for testing or more commonly as a secondary to identify a potential risk

14. A.D. Malate, BSN,RN, RAC-CT V Codes – History Codes as secondary diagnosis V10 Personal history of malignant neoplasm V16 Family history of malignant neoplasm V15 Other personal history representing hazards to health V15.81 History of non-compliance with medical treatment V15.88 Frequent Falls Examples Generally listed as second diagnosis

15. A.D. Malate, BSN,RN, RAC-CT Use of Diagnosis codes with the Minimum Date Set  Not all diagnoses reported on the MDS may be appropriate on the UB-92  For the MDS, you are selecting diagnoses and conditions relevant to a prescribed look-back period which may have been relevant at the time of MDS completion  For the UB-92, you are selecting ICD-9 codes to support the supplies and services for the dates of services being billed  Some time may have lapsed between the two so codes very appropriately selected for the MDS may no longer be relevant for the claim and vice versa.  Conditions that have been resolved or no longer affect the resident’s functioning or care plan should not be included in section I

16. A.D. Malate, BSN,RN, RAC-CT PRINTED IN MAY 05 CHIA Journal © Insights to Coding and Data Quality CMS confirms use of V-codes on UB 92 for SNF billing by Ann G Uniack, RHIA Member, Coding and Data Quality Committee The Center for Medicare and Medicaid Services (CMS) has confirmed that SNFs must use the correct ICD-9-CM codes including V codes on the UB-92 for Medicare billing. Transmittal 437 adds the following to Pub 100-04 Medicare Claims Manual, Chapter 6, Section 30, Billing SNF PPS Services. The CMS online transmittal can be accessed on the Internet at:. V54Other orthopedic aftercare For patients admitted to a SNF for care following treatment in the acute hospital for a traumatic fracture use the aftercare codes from subcategory V54.1. “Do not code the (acute) fracture.” (CC 4th Qtr 1999 p5) More recently, Coding Clinic has addressed this issue in their V code article (CC 4th Qtr 2003 p87). “There have been many questions on the use of aftercare V codes versus a diagnosis code for fractures in the healing phase. Coding guidelines require that an aftercare code be used for all subsequent encounters after the initial encounter for care of a fracture. For statistical purposes, a fracture should only be coded once. If the same fracture is coded for all encounters, it makes collection of fracture statistics difficult. The expansion last year (ICD-9-CM 2003) of subcategory V54.1 Aftercare for healing traumatic fracture, was to provide more information in the aftercare code, to eliminate the need to code the (acute) fracture. The V54.1 identifies the site of the fracture and that it is in the healing phases.” http://www.cms.hhs.gov/manuals/pm_trans/R437CP.pdf

17. A.D. Malate, BSN,RN, RAC-CT To “V” or not to “V” Scenario # 1  A resident is admitted for physical therapy following a hip replacement for an inter-trochanteric right hip fracture due to a fall.

18. A.D. Malate, BSN,RN, RAC-CT To ‘V’ or Not to ‘V’: Scenario #1  Physical therapy:  V57.1 Physical Therapy  Intertrochanteric right hip fracture due to a fall:  V54.13 Aftercare following traumatic hip fracture  Hip replacement:  V54.81 Aftercare following joint replacement  V43.64 Joint replacement, hip

19. A.D. Malate, BSN,RN, RAC-CT To ‘V’ or Not to ‘V’: Scenario #1  Diagnosis List  V57.1  V54.13  V54.81  V43.64  MDS  I-1m (hip fracture)  I-3: V54.81, V43.64  UB-92  V57.1, V54.13, V54.81, V43.64

20. A.D. Malate, BSN,RN, RAC-CT To ‘V’ or Not to ‘V’: Scenario #2  A resident is admitted for P.T. & O.T. following a hip fracture after a fall. The physician indicated that the fracture was due to osteoporosis. The Discharge Summary stated that old compression fractures of the vertebrae due to osteoporosis were present on x-ray.

21. A.D. Malate, BSN,RN, RAC-CT To ‘V’ or Not to ‘V’: Scenario #2  Physical Therapy and Occupational Therapy  V57.89 Multiple therapies  Hip Fracture (due to osteoporosis)  V54.23 Aftercare for continuing treatment of healing pathologic fracture of hip  Osteoporosis  733.00 Osteoporosis  Compression fractures of vertebrae  733.13 Pathologic fractures of vertebrae

22. A.D. Malate, BSN,RN, RAC-CT To ‘V’ or Not to ‘V’: Scenario #2   Diagnosis List   V57.89   V54.23   733.00   733.13   MDS   I-1m (hip fracture); I-1p (pathological fx);   I-1-o (osteoporosis)   I-3: 733.13   UB-92   V57.89, V54.23, 733.00, 733.13

23. A.D. Malate, BSN,RN, RAC-CT Resources: www.cms.gov Internet Only Manuals LTC Consortium ( ICD 9 Coding ) Mutual Of Omaha Medicare www.medicare.gov www.aanac.org

24. A.D. Malate, BSN,RN, RAC-CT Questions?