ICD-9 coding on section I

[greenbean21]

Okay, when adding in ICD-9 codes on Section I: For somebody S/P hip surgery to repair hip fracture, do you use V-code V58.78 (Aftercare following surgery of musculoskeletal system) or V-code V54.13 (Fracture, hip, aftercare-traumatic), when doing dressing changes to incision site, etc.? Unsure of which to use......Also, do you check I1m "hip fracture" if the hip fracture was repaired? And is it wrong to code for the actual hip fracture itself, despite surgery to repair it (ex: 820.8 for femoral neck fracture). Thanks.

[Nascar nurse, ASN, RN]

I personally mark hip fracture and then code V54.13. My surveyors would hang me out to dry for not marking hip fracture even though it had been repaired. They look for specifically for missed coding w/ falls and fractures.

[edhcinc]

Re: ICD9 coding--

V54.13 Aftercare for healing traumatic fracture of hip--is right if the joint was not replaced.

If the joint was replaced, the codes are:

V54.81 Aftercare following joint replacement AND

[instructions say to Use additional code to identify joint replacement site (V43.60-V43.69)]

V43.64 Hip

V58.78 Aftercare following surgery of the musculoskeletal system, NEC--should NOT be used, as there is a more specific code to use (NEC=Not Elsewhere Classified)

There is a "Fact Sheet" for the proper use of "V" codes at:

www.ahcancal.org/facility_operations/hipaa/Documents/Vcodes_FactSheet.pdf

We also should use the code/s for rehabilitation, if this is the primary reason for the patient's admission...below info is from the official CDC guide for ICD9 coding located at:

www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide08.pdf

Section M. Patients receiving therapeutic services only

For patients receiving therapeutic services only during an encounter/visit, sequence first the diagnosis, condition, problem, or other reason for encounter/visit shown in the medical record to be chiefly responsible for the outpatient services provided during the encounter/visit. Codes for other diagnoses (e.g., chronic conditions) may be sequenced as additional diagnoses.

The only exception to this rule is that when the primary reason for the admission/encounter is chemotherapy, radiation therapy, or rehabilitation, the appropriate V code for the service is listed first, and the diagnosis or problem for which the service is being performed listed second.

]MDS 2.0 has room only for 5 codes--MDS 3.0 will allow room us to have even more fun!!]

[Neveranurseagain, RN]

OK! I have to ask! Where/how did you become so proficient in coding? Where did you learn it at?

[edhcinc]

The best coding references are out there for all of us...

Official coding guidelines from CDC--

www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide08.pdf

and special guidelines for LTC and the use of V codes:

www.ahcancal.org/facility_operations/hipaa/Documents/Vcodes_FactSheet.pdf

Reading, sifting through and applying the information can be a daunting task..."make nice" with, and pick the brains of, your best Medicare biller and your best medical records or health information management professional.