Home Health ICD-9/ICD-10 Alert
Look for Changes in ICD-10 Fracture Coding
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Question: Our new patient is returning home after hip replacement surgery to treat a fractured left hip. We are providing aftercare for the surgery as well as physical therapy. He also has a methicillin-resistant staph infected stage III pressure ulcer on his sacrum. How should we code for him?
New York Subscriber
Answer: Assuming the aftercare for the joint replacement surgery is the focus of the care and not the pressure ulcer, code for this patient as follows:
Your focus of care for this patient is aftercare following her hip replacement, so your principal diagnosis is V54.81. You’re providing both nursing and physical therapy, so it’s not appropriate to list a V57.x (Care involving use of rehabilitation procedures) code for this patient.
Your patient had his hip replacement to repair a fracture, so this is a rare instance when you can list a code in M1024 (Payment diagnosis). List 820.8 (Fracture of unspecified part of neck of femur, closed) for this patient. While it’s acceptable to list the code for this fracture in M1024, it has no potential to earn points. The grouper counts fracture points when placed in M1024 only when you list qualifying V codes V54.1x (Aftercare for healing traumatic fracture) or V54.2x (Aftercare for healing pathologic fracture) in M1020/M1022. Those codes are not appropriate for joint replacements.
Next, list 707.03 and 707.23 to report your patient’s stage III pressure ulcer. Follow this with 041.12 to his MRSA staph infection.
Finally, list V43.64 to show that your patient had a hip replacement.
In ICD-10, for this patient you would list:
In ICD-10, you’ll also start off with the aftercare for joint replacement surgery code — Z47.1.
Next, list L89.153 to report your patient’s stage 3 pressure ulcer, and B95.62 to indicate that he has an MRSA Staph infection.
Finally, Z code Z96.642 indicates that your patient has a replaced left hip joint.
Tip: Look under “Presence of” in the alphabetic index of your coding manual to find joint replacement status codes.
Home Health ICD-9/ICD-10 Alert
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