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Home Health ICD-9/ICD-10 Alert

CODING HOW-TO:

CLOSE THE BOOK ON OPEN WOUNDS WITH FRACTURES

Published on Wed Apr 22, 2009

V codes don't always provide all the details.

When a patient has an open fracture, you can't code for the open wound. But what if the wound is actually the focus of care?

"I had a patient who had an open ankle fracture.The fracture was treated with ORIF and now has internal as well as external pins to hold the bones. The pin site is well-healed," says Pallavi Sheth, HSC-D, with Englewood Hospital Home Health & Hospice Services in New Jersey. But the wound was so involved that the patient needed muscle and skin grafts from the abdomen and thighs. The patient will require extensive wound care, and she has a mesh covering from the knee to the ankle,Sheth says.

The graft site's wound care is the focus of care. So how can you code to show both aftercare for the open wound and aftercare for the fracture?

Avoid this assumption: "When a patient has an open fracture, you should not be assigning the code for the open wound," says Nelly Leon-Chisen,RHIA, director of coding and classification with the American Hospital Association. In this example scenario,there are several aftercare codes that you could use to capture the different types of aftercare involved -- depending on the services being provided,Leon-Chisen says. For example, code V58.31 (Encounter for change or removal of surgical wound dressing) would indicate that the patient is receiving care for the surgical wound dressings. And V54.16 (Aftercare for healing traumatic fracture of lower leg) would indicate the fracture.

According to the ICD-9-CM Official Guidelines for Coding and Reporting, "Aftercare codes should be used in conjunction with any other aftercare codes or other diagnosis codes to provide better detail on the specifics of an aftercare encounter visit,unless otherwise directed by the classification."

"Unfortunately, many of the aftercare codes are not able to reflect differences in severity," says Leon-Chisen. So you'll report code V58.31 whether the wound is small or an extensive wound that had required a large graft for closure.

Coding for Complications May Not be Appropriate

"The wound created by the fracture is complicated,so would it be appropriate to use the dressing changes V code?" asks Lisa Selman-Holman,JD, BSN, RN, HCS-D, COS-C, consultant and principle of Selman-Holman & Associates in Denton Texas. And because the fracture is open and complicated is the aftercare for healing fracture code really appropriate?

"The fact that the fracture is open and complicated is important in assigning the codes from the original injury, but has no impact on assigning the aftercare code," says Leon-Chisen. Unfortunately the aftercare codes aren't that specific.

However, if the wound becomes infected, or if there is a problem with healing, then you could assign specific codes for delayed healing, infected post-op wound, or for any other complication, says Leon-Chisen.

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