Home Health ICD-9/ICD-10 Alert
Gain Case Mix Points for Pathologic Fracture
PDF
Question:
Michigan Subscriber
Answer:
If you have any questions about a fracture you suspect is pathologic, be sure to consult the physician.Pathologic fractures can be caused by a number of conditions, not just osteoporosis. For example, the patient could have had a neoplasm that caused the fracture. And some compression fractures are traumatic. So it's important to determine whether the fracture was caused by the fall (traumatic) or caused by the osteoporosis (pathological).
In your case, the physician has documented the link between the osteoporosis and the pathologic fracture. So, your principal diagnosis in M1020a for this patient is V54.27 (
Aftercare for healing pathologic fracture of vertebrae) to indicate the aftercare your agency is providing.Across from the M1020a diagnosis, in M1024, put the code 733.13 (
Pathologic fracture of vertebrae). Although the pathologic fracture is a case mix code, it rarely earns points as an Ortho 2 case mix diagnosis. Remember, coding guidelines restrict reporting fracture codes to settings providing active treatment; so these codes cannot appear in M1020 or M1022.Next, code for the patient's osteoporosis with 733.00 (
Osteoporosis, unspecified). You need to include the osteoporosis code because V54.27 doesn't include any information about the patient's osteoporosis.If you have room, you can also list the appropriate E code to describe the patient's fall. This isn't required in home health, but it is a coding best practice. However, you'll need more information about the fall to determine the exact code for this patient.
Home Health ICD-9/ICD-10 Alert
- Conquering Case Mix:
Spot Check Your CAD Coding or Risk Case Mix Points
Keep track of CABG status to find the right CAD code. Most codes in the [...] - ICD-10:
Look for Angina Pectoris Details When Coding CAD in ICD-10
Work with clinicians to capture the specific type of chest pain. When you begin using [...] - Coding 101:
Add Greater Detail with These Essential V Codes
Warning: Don't confuse 'status' and 'attention to' V codes. Home health coders and V codes [...] - ICD-10 Update:
CMS Proposes One-Year Delay for ICD-10
Don't slow down your preparations, experts advise. Have you been waiting and wondering how to [...] - You Be the Coder:
Hone in on Sequencing for Adverse Effects
Question: Our patient had two medication bottles, one labeled "Digoxin" and the other labeled "Lanoxin." [...] - Reader Question:
Consider Care Before Listing Symptom Codes
Question: I've heard it said that you should list a symptom code when the definitive [...] - Reader Question:
Mind the Documentation with Left and Right Lung Cancer
Question: Our new patient has lung cancer. The physician document states that he has a [...] - Reader Question:
Get Codes in Order for Osteomyelitis
Question: Our patient fell and broke his hip. He also has type II diabetes. While [...] - Reader Question:
Read Thoroughly for Infection Instructions
Question: We are providing aftercare following our patient's recent knee joint replacement surgery. She has [...] - Reader Question:
Gain Case Mix Points for Pathologic Fracture
Question: Our patient fell and was hospitalized for a lumbar compression fracture. She also has [...]