Home Health ICD-9/ICD-10 Alert
Take These Steps When Coding and OASIS Conflict
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Question:
Nebraska Subscriber
Answer:
This is an area where coding logic and OASIS logic collide. In coding logic, open wounds and trauma wounds are the same thing -- wounds caused by accident or violence. This includes wounds caused by animal bites, avulsions, cuts, lacerations, punctures and traumatic amputations.On the OASIS, however, the term "open wound" takes on a broader definition. OASIS item M1350 asks "Does the patient have a skin lesion or an open wound?" The "open wound" in this instance is any wound, whether a "gaping hole" or an incision closed with staples. But a patient can have an open wound in M1350 without having an open wound for diagnosis coding purposes.
In your patient's case, you are providing aftercare for surgery due to injury and trauma. The wound is still considered an open (trauma) wound, so you would report the following codes:
Because you're providing aftercare following surgery for injury and trauma, V58.43 is your primary diagnosis. ICD-9 instructs you to include other codes to identify the reason for the aftercare encounter, and V58.31 shows that you will be providing wound dressings.
Key:
Listing 891.0 shows that you are providing care for a trauma wound. While you can list this code in M1022b because it's not a resolved condition, you would get more case mix points if it was listed as the principal diagnosis. So, also list 891.0 in M1024 and you will earn added case-mix points.If the V code is primary be sure that the trauma wound code is in M1024. If the trauma wound is placed in M1024 the code will earn 8-20 points. (Be sure to repeat the code under the V code since it is a current condition.) If it is just listed in M1022, then the most points it can earn is 6.
When it comes to responding to M1340 --
Does this patient have a surgical wound? Your answer for this patient is "0" -- No. The wound is not a surgical wound. Repair of traumatic lacerations is excluded from surgical wounds on the OASIS. The answer to M1350 is definitely a "yes" because the wound is not a surgical wound, pressure ulcer, stasis ulcer or a bowel ostomy and it requires ongoing intervention from the home health agency.
Home Health ICD-9/ICD-10 Alert
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