Eli's Rehab Report
Code Correctly with Falls and Fractures
PDF
Question: Our patient is a 75 year old lady who has a history of hypertension and no other medical problems. She was walking in her kitchen when she had sudden pain in her left hip and then fell. The physician confirmed this was a pathological fracture and she had an open reduction internal fixation (ORIF) of the hip. She has been admitted to home health services for rehabilitation, including both PT and OT services. How should we code for this patient?
Answer: Code for this patient as follows, says Andrea Manning, HCS-D, COS-C, BS, RN, of Manning Healthcare Group in Talkeetna, Alaska:
When a patient has a fall and a fracture, be sure to verify the etiology of the fracture with the physician, especially if it’s not specified.
You can’t list an acute pathologic fracture on a home health claim, so instead you’ll list aftercare code V54.23 and report 733.14 in M1024 to capture the case mix points.
The only exclusion to using a V54.2x aftercare code for a pathologic fracture is when the fracture is repaired using a joint replacement. In that case, you would list V54.81 (Aftercare following joint replacement). And because V54.81 isn’t in one of the two V code subcategories that trigger M1024 (V54.1x and V54.2x) you won’t earn case mix points.
Finally, include 401.9 to indicate that patient’s HTN and V15.88 to report her history of falls. Some coders have heard a myth regarding the use of V15.88 and will not use it even when appropriate. The truth is, you can include this code when the patient has had a fall and is at risk for falls.
Caution: Even though V15.88 may be used as a primary diagnosis, it is seldom the best choice as your first-listed code.
Spontaneous fractures are always considered pathological fractures. In this case, the physician verified that the fracture occurred prior to the fall and that it was a pathological fracture, so you’ll list 733.14 rather than a traumatic fracture code.
Eli's Rehab Report
- Outpatient Outlook:
Forget the ABN and YOU Could Foot Your Patient's Therapy Bill
But take care not to use an ABN with a KX modifier. If you haven’t [...] - Inpatient Insights:
Catch Therapy-Specific Changes in the Works for 2014 SNF PPS
CMS wants therapy days vs. therapy visits crystal clear. Heads up: The Centers for Medicare [...] - ICD-10 Transition:
Tactics Put You Ahead In The ICD-10 Transition Game
As a physical therapist, you’re right in the crossfire. Being prepared for the Oct. 1, [...] - Staffing Strategies:
Size Up the Best Candidate With These Surprising Interview Strategies
Gain important clues from watching what the interviewee does with her hands and feet. Good [...] - HIPAA:
Update Your NPP Now -- Don't Wait Until The Last Minute
Make these 5 key changes to your NPP before September. If you don’t update your [...] - Human Resources:
Find Out How Well You Know Your Crew
Are your workers in the right positions for their personalities, goals, and skill sets? Assess [...] - Reader Question:
Find Out What Justifies 97112
Question: We often bill the code for neuromuscular re-education of movement for our cerebral palsy [...] - Reader Question:
Code Correctly with Falls and Fractures
Question: Our patient is a 75 year old lady who has a history of hypertension [...] - Reader Question:
Self-Care Training
Question: I just saw a patient who was recently confined to a wheelchair following a [...]