There are v-codes (meaning the ICD-9 code begins with the letter "V" followed by 2-4 digits) that designate care involving use of rehabilitation procedures. These are used when the purpose of the admission or encounter is rehabilitation. Coding guidelines only allow these encounters for rehabilitation V codes to be used as a primary diagnosis, in M1020a. They cannot be used in M1022b or beyond or in M1010 or M1016. If skilled nursing is seeing the patient for the billable visits then these encounters for rehabilitation V codes cannot be used.
There is encounter for rehabilitation V codes for physical therapy of PT is the only rehab services ordered. This is code V57.1. There is an encounter for rehabilitation V code for speech therapy if ST is the only rehab service ordered. This is code V57.3. There is also an encounter for rehabilitation V code for occupational therapy if OT is the only rehab service ordered at recertification time, this is code V57.2. Because OT cannot open a home care case under Medicare, this code will be used at recertification when OT is the only skilled discipline remaining, and going forward into the next 60 day episode.
There is an encounter for rehabilitation V code that is used when multiple therapies are ordered and provided but no nursing. This code is V57.89. It is used with any combination of PT, OT and ST or if all 3 therapies are involved with no nursing. Again, this code can only be used as the primary diagnosis in M1020a.
There is one more encounter for rehabilitation therapy code we see in home care, V57.81, For Orthopedic training, meaning cat training in the use of artificial limbs. This can only be primary diagnosis as well. The patient's amputation stump has matured and has been fitted for prosthesis and a physical therapist will train the patient in the use of the prosthesis in the home setting. Documentation must show why the patient remains homebound since this training is usually several months after the original surgery and often done in an outpatient setting.
Remember, use encounter for rehabilitation V code only as a primary diagnosis in therapy only cases when skilled nursing has not been ordered.