Home Health ICD-9/ICD-10 Alert

Question: Our patient is recovering from amputation of his right big toe due to gangrene caused by chronic gouty arthropathy of the foot. Our focus of care is physical therapy for transferring, training, bed mobility, and caregiver training. The patient also has unstable hypertension (HTN). Nursing will assess the effectiveness of the patient’s hypertension medication. He also has a history of CVA with resulting muscle weakness, and difficulty in walking. How should we code for him?

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Answer: Code for this patient as follows:

• M1020a: V54.89 (Other orthopedic aftercare);
• M1022b: 274.02 (Chronic gouty arthropathy without mention of tophus [tophi]);
• M1022c: 401.9 (Essential hypertension; unspecified);
• M1022d: 438.89 (Other late effects of cerebrovascular disease);
• M1022e: 728.87 (Muscle weakness [generalized]); and
• M1022f: V49.71 (Lower limb amputation status; great toe).

In this scenario, your focus of care is aftercare for the patient’s amputation surgery, so V58.49 is your principal diagnosis.

Follow this with the gouty arthropathy code in M1022b because the patient still has this condition following the surgery. Then list a code for the patient’s hypertension.

Since the patient’s muscle weakness is a late effect of an old CVA, you’ll list 438.89 before you code the muscle weakness.

It’s not necessary to include a code for difficulty walking because the gouty arthropathy is the patient’s definitive diagnosis.

To code for this patient in ICD-10, you would list the following codes:

• M1021a: Z47.81 (Encounter for orthopedic aftercare following surgical amputation);
  
• M1023b: M1A.0710 (Idiopathic, chronic gout, right ankle and foot; without tophus [tophi]);
  
• M1023c: I10 (Essential [primary] hypertension);
  
• M1023d: I69.398 (Other sequelae of cerebral infarction);
  
• M1023e: M62.81 (Muscle weakness [generalized]);
  
• M1023f: Z89.411 (Acquired absence of right great toe).