Wiki Geriatrics/Inpatient/Long-Term Care Coding


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Fellow Coders,

I work in a skilled nursing facility with a small number of long-term care beds. We have a few Hospice patients. I know coding here is very different from most inpatient and outpatient facilities, but I find that the specific regulations surrounding coding are hard to find. Even here on AAPC, there isn't a forum for this specified type of facility. Is there anyone that is a specialist in this type of faciliy? I have a hard time coding the aftercare versus acute codes in this facility.

For example:
A patient comes in s/p a surgery to remove a neoplasm (regardless of body system...let's just say brain)

  1. Code the aftercare of the surgery
  2. Code the surgical dressings
  3. Irraddiation/Chemo

Now, after this is where I get foggy. My MDS girls insist I need to code the mal. neoplasm...but it's been cut mets or other remaining shouldn't I code it as historical?

Another example:
A patient comes in s/p a surgery to replace a joint (again, doesn't matter which, we'll just say knee) due to osteoarthritis

  1. Code the aftercare of the surgery (joint replacement)
  2. Code the joint replacement itself
  3. Code the surgical dressing
  4. Code the therapy

Do I code the OA for that joint, even though s/p the replacement there is no OA in that joint??

And this list goes on and on:
Abdominal abscess s/p removal
Joint infection s/p I&D

What about strokes? When they have a CVA, the sources I've found all say that you don't code late effects until after 2 weeks, otherwise they're expected side effects you don't code. But my girls insist they need these codes...what do I do for this??

I obviously have a lot of LTC coding questions. If I could find someone that is able to answer a few questions and guide me, I'd really appreciate it.