Home Health & Hospice Week

Tip:  Focus on multiple aspects of an underlying disease.

Learning when to report 728.87 for muscle weakness or 728.2 for muscle wasting will help boost your bottom line as well as your coding accuracy.

Use code 728.2 (Muscular wasting and disuse atrophy, not elsewhere classified) when documentation shows a measurable decrease in the size of the muscle groups, says Lucie Carter Lopez, clinical supervisor with Interim Health Care in Fresno, CA. "I'd stay away from 728.2 unless you actually have muscle measurements to document, and that doesn't happen really often," she says.

Red flag: Payors expect the decrease of the muscle groups to be documented, and you can expect downcoding if you don't have a record of these measurements.
Report 728.87 For Muscle Strengthening Report 728.87 (Muscle weakness [generalized]) as primary when progressive muscle strengthening is the focus of care, says Jun Mapili, rehab therapies supervisor with Global Home Care in Troy, MI. For therapy-only cases with a focus on muscle strengthening, list 728.87 as the first secondary diagnosis following V57.1 (Other physical therapy), he says. You should also list 728.87 in M0245a as the payment diagnosis in this therapy-only scenario.

Identify the proximate condition: Although muscle weakness can be considered a symptom of another condition, the code 728.87 was added in 2003 to describe the "unique condition" of muscle weakness.

However, some intermediaries consider muscle weakness a symptom or sign of another condition. So you should make your code selection based on the proximate-condition-versus-the-underlying-condition concept. Using this guideline, avoid coding a long-term chronic condition first when the focus of the care (the proximate reason) is muscle weakness.

You'll typically report muscle weakness for patients with neurological diseases such as Parkinson's disease, amyotrophic lateral sclerosis (Lou Gehrig's disease), multiple sclerosis, myasthenia gravis, and Alzheimer's disease, Mapili says. However, you can also use muscle weakness to describe the residual effect of orthopedic conditions such as fractures, hip joint replacement (arthroplasty), and amputation. Know When To Report The Underlying Diagnosis Knowing when to code for the condition that causes the muscle weakness ensures that your agency gets all the reimbursement it deserves for these complex patients.

Neurological cases garner more money in the clinical domain of the OASIS, earning 20 points as compared to 11 points for muscle weakness, Mapili points out.

Tip: The key to coding correctly is to look at the aspects of care being addressed, Mapili says.

If the therapist is addressing multiple aspects of care, you can report the underlying diagnosis (such as myasthenia gravis) as primary rather than the proximate diagnosis (muscle weakness), Mapili says.

For example: In a therapy-only case, the therapist is addressing the disease process, functional training and progressive muscle strengthening. This would be considered multiple aspects of care, Mapili says. However, if [...]