June 27, 2011

“Code V57, Where are You?”


When coders for inpatient rehabilitation facilities were instructed to use a code from the V57.xx series to indicate principal diagnosis, there was a loud howl of protest from those who felt that these codes did not represent diagnoses but rather the treatment a patient would receive.

It was inconsistent, as staff did not report a code to admit for medical care or a code to admit for surgery. However, this was an efficient method through which to group a patient to DRG 462 for rehabilitation. Rehabilitation facilities excluded from the DRG payment methodology also were instructed to use this code to indicate principal diagnosis.

The 2002 implementation of the IRF PPS included completion of the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF PAI). The IRF PAI required code assignment for the etiology, comorbid conditions, complications and reasons for interrupted stays or death.    The IRF PAI instructions for code assignment mandated the etiology-advised coders to report the diagnostic code for the acute condition that was responsible for the impairment. This was unusual, and ran contrary to how the official guidelines instructed coders to operate.

Once again, coders had to accept change, although they did not understand why code V57.89 couldn’t be reported as the etiology, as it was appropriate for the billing form. The response to this was that the billing form and the IRF PAI are separate documents. The IRF PAI is a separate data set, meaning the Official ICD-9-CM Guidelines for Coding and Reporting do not apply to code assignment for it.

Then Came MS DRGs

With the introduction of Medicare Severity – Diagnostic Related Groups (MS –DRGs), the rehabilitation DRGs changed to DRG 946, rehabilitation with major complication/comorbidity (MCC), and DRG 945, Rehabilitation without CC or MCC.

ICD-9-CM codes for the principal diagnoses that assign DRGs 945 or 946 include:

V52.8            Fitting and adjustment of other specified prosthetic device

V52.9    Fitting and adjustment of unspecified prosthetic device

V57.1    Other physical therapy

V57.2            Occupational therapy and vocational rehabilitation

V57.3    Care involving use of rehabilitation speech-language therapy

V57.89 Other specified rehabilitation procedure

V57.9            Unspecified rehabilitation procedure


It is possible to map codes V52.8 and V52.9 to ICD-10-CM codes in the Z44 series of codes. These codes seldom are used as a principal diagnosis by inpatient rehabilitation facilities.

The official ICD-9-CM coding guidelines indicate that only one code from the V57 series of codes should be reported. Inpatient rehabilitation facilities report code V57.89 for inpatient admissions to indicate that a patient will receive therapy in multiple therapy disciplines.

Mapping Won’t Get You There

A simple mapping of the V57 series of codes found in ICD-9-CM over to ICD-10-CM is not possible, as codes that duplicate the V57 series currently are not included in ICD-10-CM classification.  Inpatient rehabilitation coders will need to be flexible, as change is inevitable. How to assign the inpatient rehabilitation DRGs when ICD-10-CM is implemented is a matter still being studied.

One possible solution for assignment of the rehabilitation DRGs is to add additional codes to the ICD-10-CM classification, replacing the current V codes used for ICD-9-CM. Another possible solution would be to map to the rehabilitation DRGs the ICD-10-PCS procedure codes for Physical Rehabilitation and Diagnostic Audiology, F00-F15.

A solution will need to be found prior to Oct. 1, 2013.

About the Author

Patricia Trela, RHIA, is the director of HIM and rehabilitation services for Diskriter, Inc., a consulting firm offering integrated HIM rehabilitation consulting services, including HIM Interim management, IRF PPS compliance and education, coding and auditing support, dictation/transcription, and other solutions. She has more than 25 years of healthcare industry experience.  As a consultant, Pat has worked with many acute-care hospitals, rehabilitation hospitals and long-term acute-care hospitals (LTACH).  Pat facilitates the AHIMA Coding Physical Medicine Rehabilitation Community of Practice (COP).

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Read 415 times Updated on September 23, 2013