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Reader Question:

Read Thoroughly for Infection Instructions

Published on Tue May 15, 2012

Question: We are providing aftercare following our patient's recent knee joint replacement surgery. She has a methicillin resistant Staphylococcus aureus infection surrounding her knee prosthesis. How should we code for her?

Alabama Subscriber

Answer: For this patient, list the following codes:

  • M1020a: 996.66 (Infection and inflammatory reaction due to internal joint prosthesis);
  • M1022b: V43.65 (Organ or tissue replaced by other means; joint; knee); and
  • M1022c: 041.12 (Methicillin resistant Staphylococcus aureus).

There are two instructional notes in the tabular list of your ICD-9 manual that you must heed in order to code correctly for this patient.

First, under the subcategory 996.6x (Infection and inflammatory reaction due to internal prosthetic device, implant, and graft), you'll see a note reading "Use additional code to identify specified infections." That means you should list the causative organism for the infection, if known. In this case, you'll list 041.12 for the Methicillin-resistant Staph infection.

Second, under code 996.66, you're instructed to list "Use an additional code to identify infected prosthetic joint (V43.60-V43.69)." That's V43.65 in you patient's case. You can sequence the V43.65 code later on in your list -- it doesn't have to follow immediately below 996.66.

Mistake: You shouldn't report V54.81 (Aftercare following joint replacement surgery) because there has been a complication.

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