Home Health ICD-9/ICD-10 Alert

Published on Tue Jan 03, 2006 PDF

Question: I have a patient with a traumatic hip fracture. Skilled nursing has been ordered for pain. The patient has had no open reduction internal fixation of the fracture. How do I code for this patient? Do I put anything in M0245?


Washington Subscriber

Answer: The nurse is providing aftercare for the traumatic fracture so the primary code is V54.15 (Aftercare for healing traumatic fracture of upper leg). Use the aftercare for healing traumatic fracture codes for all treatment of the fracture, not just surgery.

You may place the code for the hip fracture, such as 820.8 (Fracture of neck of femur, Hip NOS) in M0245 for HHRG calculation. Instructions for completing M0245 direct you to use the B-1 2000 OASIS instructions. Ask yourself, "What would I have coded for this patient before I started using V codes?" That would most likely be the fracture code. Do not also code the fracture code in M0240. That is a violation of the coding rules.

Whether to use a V code or a diagnosis code for fractures in the healing phase continues to confuse coders. You should use an aftercare code for all subsequent encounters after the initial encounter for care of a fracture, the coding guidelines state.

For statistical purposes, a fracture should only be coded once. If the same fracture is coded for all encounters, it makes collection of fracture statistics difficult.

The expansion of subcategory V54.1x (After-care for healing traumatic fracture) in 2002 was in-tended to provide more information in the aftercare code and eliminate the need to code the fracture, according to Coding Clinic, Fourth Quarter 2003. The V54.1x code identifies the site of the fracture and that it is in the healing phases.