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Ask the Expert

This month’s selection:
A patient was admitted to an acute care facility with a subarachnoid hemorrhage. He had a craniotomy with evacuation of subarachnoid hemorrhage and was later transferred to a long term acute care facility. Would the proper code be V58.73, Aftercare following surgery of the circulatory system, not elsewhere classified? The patient would no longer have the subarachnoid hemorrhage, as it had been removed. I have tried explaining to a colleague with the entire operative procedure, but she is still coding it as if the patient still has the subarachnoid hemorrhage.

Ronda R. Hajduk, MBA, RHIT, CCS
Ernest Health, Inc


Coding depends on the specific acute condition still receiving care at the long term acute care facility.

If the patient is ventilator dependent because of respiratory failure, then the respiratory failure and ventilator dependence codes may be the first and second diagnosis codes.

A persistent vegetative state after the subarachnoid hemorrhage is resolved may be coded 780.03 with 438.89 (persistent vegetative state plus late effects of cerebrovascular disease).

The V code you suggested is vague, and one would hope there’s something more specific in the chart than just “surgical aftercare.” Without having that documentation, I can’t be more specific about the proper code.

Coding Clinic (first quarter, 2012, page 19) acknowledges the difficulty on a sepsis patient, which is a similar issue to a subarachnoid hemorrhage:

“The Editorial Advisory Board for Coding Clinic has become aware of a pattern of documentation problems concerning patients transferred to the LTCH [long term care hospital] with a diagnosis of sepsis. Physician advisers reviewing these cases did not agree that these patients were truly septic since they had no clinical indicators. If the documentation is unclear as to whether the patient is still septic, query the provider for clarification. Facilities should work with the medical staff to improve physician documentation and address any documentation issues. Please refer to the Fourth Quarter 2003 issue of Coding Clinic, pages 102-103, for additional information regarding coding and reporting for long term care hospitals.”

This issue refers the coder back to 2003, fourth quarter, pages 102-103: “The Official Guidelines for Coding and Reporting also apply to LTCH coding. Section I of the guidelines apply to all healthcare settings. Section II (Selection of Principal Diagnosis) and Section III (Reporting Additional Diagnoses) have been clarified to apply to long term care hospitals. Depending on the medical record documentation, LTCHs may assign codes for acute unresolved conditions or code(s) for late effect or rehabilitation.”

Advice or recommendations provided have been given based on the review of the information provided. Harris County Hospital District cannot be held liable for any advice, findings, or recommendations given that could have had a variable answer based on additional information.

— Judy Sturgeon, CCS, CCDS, is the clinical coding/reimbursement compliance manager at Harris County Hospital District in Houston and a contributing editor at For The Record. While her initial education was in medical technology, she has been in hospital coding and compliance for 22 years.