Wiki PLEASE I'M Having a moment and need someone guidance ASAP on one

[darmandahl]

Musculoskeletal Chief Complaint: I fell and hurt my right hip.
History: Patient is a 74-year-old male who tripped over a rug at home, fell and had immediate pain in his right hip. He was transported to the Emergency Department by ambulance. In addition to his hip pain, he has a history of high blood pressure currently treated with zaroxolyn and lisonopril. He admits that he has been in the habit of cutting his BP pills in half to save money on refills. He also has a history of a myocardial infarction several years ago without any current manifestations.
Review of Systems, Physical Exam, and Tests:  Patient denies any symptoms other than hip pain. Specifically denies any recent history of chest pain, arm pain, epigastric pain or shortness of breath.  VS: BP on admission to the ED – 180/95  X-rays: Right intertrochanteric hip fracture. No evidence of other bony injury  EKG: evidence of old myocardial infarction. No evidence of recent myocardial injury. Treatment in ED:  Patient given IV medications for pain (morphine 1-2 mg IV titrated for relief)  BP after IV medication – 165/90 Assessment and Plan:  Admit to hospital.  NS IV at 75 cc/hour.  Pain medications – morphine 1-2 mg IV prn.  NPO for surgery.  Orthopedic surgery and anesthesia consults.

Apply the correct diagnoses codes: I CAME UP WITH S72.00; I25.2; R03.0 BUT WAS TOLD THAT FIRST AND LAST ARE BOTH WRONG AND THERE SHOULD BE A TOTAL OF 8 CODES! OMG fractures have always just made me run! please some directions and thoughts or the codes right now would just make my day. I'm going to have to stop running from fractures and embarrasse them I see. please I need done by 5pm California time and my head just hitting the desk over this one today.

 

[Sundancer]

Yes, you need more!

Fracture - R Intertrochanteric Hip is going to be under S72.14-- ...does the note or XR specify displaced/non-displaced? If not, per guidelines assume displaced. Open or Closed? If not, assume closed. So most likely S72.141A for Displaced, Closed Intertrochanteric Fx R Hip, Initial Encounter.

Then you need your external cause codes to follow the frx code:
Cause: W01.0XXA Fall same level slipping, tripping, stumbling w/o striking other object*, Initial
Place: Y92.009 Unspecified place in unspecified residential (non-institutional) private residence (UNLESS it states he lives in a nursing home, etc)
Activity: ?? don't see any specific stated, so can't code it. Skip it.

(*the floor itself doesn't count, because, well, it's not a fall if he doesn't hit the floor! They want to know if he hit any objects on the way down eg furniture).

The R03.0 is for Elevated BP w/o Formal dx of HTN, so yes, this is wrong. If the pt has known HTN, then you code I10 for Hypertension, or possibly I11.9 for HTN w/o HF (no mention of HF w the MI). Not so clear on this one myself. Sequence it after the I25.2 - see section guidelines, it instructs you to code additional for presence of HTN.

As far as needing 8 codes, the only other thing I can see is perhaps you need to code for the pt cutting his BP pills?
Zaroxolyn per Drug Table = T50.2X6A Underdosing of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, Initial
Lisinopril = T46.4X6A Underdosing of angiotensin-converting-enzyme inhibitors, Initial
And "Use Additional" instructs to add Z91.120 - Patient's intentional underdosing of medication regimen due to financial hardship

That does make 8! Try those and see if you get a better result. Hope that helps!