Home Health ICD-9/ICD-10 Alert

Question: Our new patient is receiving skilled nursing, physical therapy, and occupational therapy following a cerebrovascular accident (CVA). He has hemiplegia in his right, dominant side, and apraxia. He is on Coumadin for which we will provide teaching and monitoring. How should we code for this patient?

Answer: List the following codes for your patient:

• M1020a: 438.21 (Late effects of cerebrovascular disease; hemiplegia affecting dominant side);
• M1022b: 438.81 (Other late effects of cerebrovascular disease; apraxia);
• M1022c: V58.83 (Encounter for therapeutic drug monitoring); and
• M1022d: V58.61 (Long term [current] use of anticoagulants).

You’ll list late effect codes for your patient’s hemiplegia and apraxia. Both of these conditions have combination codes that describe the diagnoses as the late effects of a CVA.

Add two V codes to describe your care surrounding the patient’s Coumadin: V58.83 to indicate that you will be providing drug monitoring and V58.61 to describe the type of drug prescribed.

In ICD-10, you would list the following codes for this patient:

• M1021a: I69.351 (Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side);
• M1023b: I69.390 (Apraxia following cerebral infarction);
• M1023c: Z51.81 (Encounter for therapeutic drug level monitoring); and
• M1023d: Z79.01 (Long term [current] use of anticoagulants).

Although the codes themselves look different, the process of coding for this patient in ICD-10 is similar to the way you code in ICD-9. 

Your first two codes for this patient are combination codes that indicate your patient is receiving care for hemiplegia and apraxia as sequela of a CVA. Sequela is the term for late effects in ICD-10. Notice that in ICD-10, the code for hemiplegia indicates whether this condition affects the dominant side and which side (right or left) is affected.

Once again, your second two codes for this patient indicate that you will be providing therapeutic drug monitoring for the patient’s anticoagulant (Coumadin).