Home Health ICD-9/ICD-10 Alert
Use Multiple Codes for Multiple Fractures
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Question: Our new patient comes to us after a car accident. She went from the hospital to an inpatient rehab before coming home. She is recovering from multiple trauma wounds, including a right pubic ramus fracture and a left acetabular fracture with sacroiliac dislocation for which she underwent an open reduction internal fixation. She also has a healing left fibular fracture, multiple left rib fractures, and a left clavicle fracture. Skilled nursing will be providing wound care and physical therapy, and will address the patient's abnormal gait and muscle weakness. Physical therapy is providing the most visits. How should we code for her? -- New Mexico Subscriber Answer: For this patient, list the following six codes: • M0230a/M1020a: V54.13 (Aftercare for healing traumatic fracture of hip) • M0240b/M1022b: 781.2 (Abnormality of gait) • M0240c/M1022c: 728.87 (Muscle weakness [generalized]) • M0240d/M1022d: V54.19 (Aftercare for healing traumatic fracture of other bone) • M0240e/M1022e: V54.16 (Aftercare for healing traumatic fracture of lower leg) • M0240f/M1022f: V54.17 (Aftercare healing traumatic fracture of vertebrae). Your primary care focus is the patient's hip fracture. This injury required surgical intervention and is a major contributor to the patient's need for physical therapy. So, list V54.13 first. Follow your principal diagnosis with the diagnoses that indicate the need for physical therapy. In this case, that means the patient's abnormal gait and muscle weakness resulting from atrophy and decrease in strength as she recovered from the accident. Next, list V54.19 -- this code will cover both the healing traumatic fracture of the pubic ramus and the clavicle fracture because there are no more specific codes to describe these particular fractures. Finally, list V54.16 and V54.17 to indicate the patient's left fibular and rib fractures. Capture Case Mix Payment Ordinarily, you would list the fracture code in M0246 across from the V codes, but that's not the case if this is not a Medicare patient. Remember the fracture codes cannot be listed in M0230 or in the M0240s because home health does not provide active treatment. There is some debate as to whether abnormality of gait and muscle weakness is appropriate to code in this type of situation. As we receive additional information from official sources, we will update the scenario accordingly.
Home Health ICD-9/ICD-10 Alert
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