Home Health ICD-9/ICD-10 Alert

Conquering Case Mix: Test Your Weakness Coding Savvy With This Case Study

List 585.6 if your patient is receiving dialysis, no matter what stage. Listing a code from the 728.x category (Other disorders of muscle, ligament, and fascia) can add 11 case mix points to your claim. But to secure those points, you'll need to be certain your documentation contains specifics.

Coding scenario: Your patient has chronic renal failure and was on peritoneal dialysis. She went to the hospital for removal of the PD catheter and insertion of a fistula. When she returned home, your therapist found muscle weakness that will require more than 10 visits. The patient has a 23-cm incision with 30 staples open to air. You won't be doing any wound care, just assessment of the surgical area. The patient is diabetic and her physician says she is in stage-IV renal failure, but he can't confirm that diabetes caused the renal failure.

Code for this patient as follows, suggests Judy Adams, RN, BSN, HCS-D, with LarsonAllen in Charlotte, NC:

• M0230a: V58.76 (Aftercare following surgery of the genitourinary system, NEC);
• M0240b: 728.87 (Muscle weakness [generalized])
• M0240c: 585.6 (End stage renal disease);
• M0240d: 250.00 (Diabetes mellitus without mention of complication; type II or unspecified type, not stated as uncontrolled); and
• M0245a: 728.87 (Muscle weakness [generalized]).

Do this: For extensive muscle weakness that is not expected to reverse without physical therapy, 728.87 is the appropriate code, says Adams. But use of this code, she says, assumes that the physical therapist is able to:

Payoff: List 728.87 in M0245 because this weakness code would have been the primary diagnosis before the use of the V codes in home health, Adams says. The physical therapist's services to improve strength appear to be the most intensive follow-up care after the surgery.

Use 585.6 to code for the chronic kidney disease, rather than 585.4 (Chronic kidney disease, Stage IV [severe]). Although the physician says the patient has stage-IV chronic kidney disease, the patient requires chronic dialysis, first through the peritoneal dialysis catheter and now via the A-V fistula, Adams says. Regardless of the stage, the instructions under 585.6 indicate that this is the correct code for chronic kidney disease requiring dialysis.

Another way: Looking at the same scenario, you might consider the muscle weakness as primary, says Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates in Denton, TX. Based on the information given, the muscle weakness isn't necessarily the result of the surgical procedure, she says. If this turns out to be the case, sequence the muscle weakness first and then list V58.76 as a secondary code.

Remember: Listing 728.87 as primary instead of a V code means you wouldn't list a code in M0245, says Selman-Holman.