Home Health ICD-9/ICD-10 Alert

Don't list 728.2 for weakness following a brief hospitalization.

Could your weakness coding muscles use a workout? Find out which diagnoses support therapy -- and which don't -- to strengthen your physical therapy claims.

There are four weakness symptom codes related to physical therapy, Sparkle Sparks, MPT, HCS-D, COS-C, with Redmond, WA-based OASIS Answers Inc. pointed out during a recent Eli Research audio conference on therapy coding, "Overcome V57.1-itis And Other Common Therapy Coding Challenges."

While their descriptors can seem frustratingly similar, some of the codes support therapy and bring case mix points, while others simply add detail to the story of your patient's condition.

Report 728.87 For Deconditioning

Code   (Muscle weakness [generalized]) is frequently reported to describe a home health patient's weakness. Neurologists requested this code be added with the 2003 ICD-9 update because they felt the existing code, 728.9 (Unspecified disorder of muscle, ligament, and fascia), didn't do a good job of describing muscle weakness, says Sparks. Code 728.87 is used to report the "unique" condition of muscle weakness, according to the American Hospital Association's quarterly Coding Clinic.

When to use it: Report deconditioning or a general decrease in muscle strength with 728.87. You can also use this code to describe weakness of unknown etiology, says Sparks. But be sure your plan of care includes documentation of a manual muscle test indicating the patient isn't of normal strength.

Also make sure the plan of care shows interventions such as therapeutic exercises, cautions Sparks.

Beware: Because 728.87 is a case mix code, it may bring additional scrutiny to your claims. Be sure the documentation supports your use of this code.

While 728.87 may be on some local coverage determination lists of codes that support physical therapy, at least one fiscal intermediary requires an additional code to explain further why the patient is weak, says Sparks. Be sure to check with your FI for clarification on when to use this code.

Caution: The non-essential modifier "generalized" in the descriptor for 728.87 can lead to some confusion with this code. Use 728.87 to report generalized muscle weakness, not generalized weakness, urges Sparks. The word "generalized" was added to clarify that the code can be used for generalized muscle weakness; not just weakness of one muscle group.

When not to use: Don't use this code if you aren't providing therapeutic intervention to treat the patient's weakness, advises Sparks.

List 728.2 For Measurable Muscle Atrophy

Use 728.2 (Muscular wasting and disuse atrophy) -- also a case mix code -- to describe muscle weakness of a long-term nature, says Sparks. The documentation should support a measurable decrease in the size of muscle groups or a prolonged period of inactivity, she says. Check with your FI to see if this code is on its list of diagnoses that support physical therapy.

If your physical therapist does circumferential measurement of the patient's limbs, the measurements should show that one limb is a lot weaker or smaller than the other.

When not to use: Don't report 728.2 for a patient who is weak after a brief hospital stay, says Sparks. Use 728.2 for patients with long-term weakness.

Caution: When reporting 728.87 or 728.2, make sure therapy is measuring and addressing the weakness, says Cindy Krafft, director of rehabilitation for OSF Home Care based in Peoria, IL. Many people stop at trying to use one of these codes to "justify" therapy but don't look at the therapy documentation to confirm the manual muscle tests and strengthening activities are occurring, she says. "I still see charts that use these codes and do not even order therapy. It ends up being a decision about 'points' and not about the role of the diagnosis in the treatment plan,"  Krafft notes.

In addition, if your patient's HIPPS code reflects a HHRG indicating a functional status code of F0 or F1, your FI may question why you're reporting case mix diagnoses 728.87 or 728.2, says one coding expert. If the functional score is F0 or F1, it means your patient is independent and safe in their activities of daily living (ADLs). "If he is so safe, how can he be so weak?" the expert asks.

Use 780.79 For Short-Term Fatigue

Use 780.79 (Other malaise and fatigue) to report for weakness, lack of strength, loss of energy, lethargy, listlessness ...quot; the type of weakness that may follow viral infection, says Sparks. Code 780.79 will not give you any case mix points.

When to use it: If nursing is addressing weakness for a patient who is really weak and "out of it," and therapy isn't addressing the weakness, that's when to use this code, says Sparks.

May not support therapy: At least one FI doesn't list this code in its local coverage determination for physical therapy. Check with your FI to see where it stands.

Try this: To determine when to report 780.79, remember the following scenario, suggests Sparks. You've been out of work with the flu for a few days. You're at home and you start to feel better so you decide to go back to work. Back at work, you're so debilitated you can hardly make it through the day. Code yourself a 780.79, she says. "You just need time to recover. You don't need PT, you just need a few days to get your strength back," explains Sparks.

799.3 Documents More Extensive Problems

List 799.3 (Debility, unspecified) after the condition that causes the debility. This diagnosis won't give you any case mix points.

When to use it: Report 799.3 for frail, infirm, feeble, or weak patients, says Sparks. "It's a good description of why it might take you a while to make these folks better," she says.

Doesn't support therapy: Code 799.3 doesn't justify physical therapy, says Sparks.

Note: For a detailed discussion of therapy-coding issues, order the tape or CD of Sparks' teleconference "Overcome V57.1-itis And Other Com-mon Therapy Coding Challenges," at http://codinginstitute.com/conference/tapes.cgi.