Published Jun 18, 2004
When Answering Mo245 On Oasis The Rule Is Only Use It If A V-code Replaces A Casemix Diagnosis In Mo230-ortho, Diabetic, Neuro, Or Burns Trauma. I Read An Article From Beacon Health Stating To Also Put This Icd-9 Code In Mo240...so Your Secondary Diagnosis In M0240 Matches M0245. Is This The Way Your Agency Is Using V-codes? No One Is Coding Mo245 For Fitting Urinary Devices Or Anticoagulant Therapy Unless Your Secondary Diagnosis Was A Stroke...right?
We use v-codes for anticoag tx after hip replacements, pacemeker inserts, and various other surgeries; also with lupus and Factor 12 d/o. V-codes are used when the underlying diagnosis is no longer an active factor for the services provided. If your pt had MRSA with a PICC placement but the infection is resolved and service is to maintain the line, you'd use the v-code and place the MRSA as the case mix dx. Until they allowed the use of v-codes, the 485 looked like you were treating the resolved problem. Be careful though-- if you are teaching the pt about lupus and doing PT/INR draws, the lupus is the primary dx for the treatment plan. The CMS website has an OASIS manual plus some tutorials that may help (or confuse you beyond belief!! LOL). http://www.cms.gov
CardioTrans, BSN, RN
We dont use fitting of urinary device or anticoagulant therapy in 245 at all. Once the pt has come home the CVA is no longer acute. we do use the vcodes for foleys and PT/INRs but as 3rd or 4th diagnosis. If the pt had a CVA, then 9 times out of 10 we have orders for PT. So we use 240a V571 for Encounter for PT, then 240b 7812 (Abnormality of Gait) as secondary. the 7812 we also put in 245. Then the CVA code is usually a 240c late effect CVA code. Then the lab v codes or foley v codes. Clear as mud, right?
Uh-oh! I've been using acute CVA if it is the first round of progressive care for a fresh CVA (hospital to rehab to home) and late effects after max functional status has been reached and then declined . . .
renerian, BSN, RN
There really is no time frame specified by acute CVA vs late effects CVA. Some reading guestimates a 6 to 8 week period of time but that can be debated so I think your fine.
I would not use a VCode in MO245 (for another poster)
THANKS FOR THE WEBSITE...CLEAR AS MUD IS RIGHT...BUT I THINK I HAVE IT NOW. CMS STATES DO NOT COMPLETE MO245 IF A V CODE HAS BEEN REPORTED IN PLACE OF DIAGNOSIS THAT IS NOT A CASE MIX DIAGNOSIS. THAT IS WHAT I WAS LOOKING FOR.
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