Home Health ICD-9/ICD-10 Alert

Question: We are caring for a patient who has come home from the hospital with a new pacemaker and a total hip replacement. We are caring for both. She went to the hospital for the hip replacement, but had to have a pacemaker installed before the hip replacement could be done. Which aftercare code should I list first? She also has diabetes with hypoglycemia.

Answer: You have two choices of primary diagnosis codes in this case, V58.73 (Aftercare following surgery of the circulatory system, NEC) and V54.81 (Aftercare following joint replacement).

The official coding guidelines state that when two diagnoses both meet the definition of primary diagnosis, you should just choose one. Otherwise you should code the diagnosis requiring the most intensive services.

Additional code: Both of these appropriate aftercare codes have status codes that you should also report: V45.01 (Cardiac device in situ; cardiac pacemaker) for pacemaker status and V43.64 (Organ or tissue replaced by other means; joint; hip) for hip joint.

But be careful not to fill in your diagnosis coding slots with too many additional V codes before your report the patient's co-morbidities, such as the heart arrhythmia which required the pacemaker and the diabetes. Diabetes with hypoglycemia is coded 250.80 (Diabetes with other specified manifestations; type II or unspecified type, not stated as uncontrolled).