Home Health ICD-9/ICD-10 Alert

Question: A patient is admitted for home care with a diagnosis of pancreatitis. The focus of care is skilled nursing to administer hyperalimentation using a PICC line. What codes do you use and which one is first?

Answer:  You must gather more information to answer this question. First, ask if the skilled nursing focus is on more than administering the total parenteral nutrition, Selman-Holman suggests.

Also ask why the patient needs TPN, Dilts-Benson advises. The reason probably would not be pancreatitis, but rather some underlying malnutrition. It could also be the need to rest the gut to treat the pancreatitis, she says.

If you decide the focus of care is only on administering total parenteral nutrition, then you would code V58.81 (Fitting and adjustment of vascular catheter) first. Then code the underlying reason - either a specific code for the type of malnutrition or 269.9 (Unspecified nutritional deficiency) - followed by 577.0 (Acute pancreatitis), Dilts-Benson suggests.

If you decide the focus of care is broader - such as assessing the patient's nutritional state - then code the malnutrition code first, followed by V58.81 and then 577.0, Selman-Holman recommends.