Home Health ICD-9/ICD-10 Alert

Question: Our patient has osteoarthrosis of the knees and the hips. We will be providing physical therapy for strengthening, gait training, fall precautions and pain management. We will also be providing skilled nursing to instruct, teach and administer IV antibiotics to treat acute osteomyelitis of his left hand and an infected stage II pressure ulcer of the coccyx with methicillin resistant Staphylococcus aureus (MRSA). How should we code for this patient?

Vermont Subscriber

Answer:
Report the following codes for this patient:

• 730.04 (Acute osteomyelitis; hand);
• 707.03 (Pressure ulcer; lower back);
• 041.12 (Methicillin resistant Staphylococcus aureus);
• 707.22 (Pressure ulcer, stage II);
• 715.96 (Osteoarthrosis, unspecified whether generalized or localized; lower leg);
• 715.95 (Osteoarthrosis, unspecified whether generalized or localized; pelvic region and thigh);
• V58.81 (Fitting and adjustment of vascular catheter); and
• V58.62 (Long-term [current] use of antibiotics).

Reporting 715.95 will earn you case mix points because you are also providing IV/infusion so you’ve met the requirements to receive case mix points for Ortho 2 diagnoses. You won’t earn the points because you’ve included a code for the IV (V58.82), but because the answer to M1030 — Therapies the patient receives at home is “1” for infusion therapy.

You won’t earn additional case mix points for the patient’s acute osteomyelitis (730.04) because the osteoarthrosis and osteomyelitis codes in this case are both Ortho 2 case mix codes.

List 707.03 for your patient’s pressure ulcer of the coccyx and 707.22 to indicate that it is stage II. ICD-9 coding guidelines also require you to list the organism causing an infection if it’s known, so you should add 041.12 for MRSA. In this case the sequencing of the MRSA can be before or after the stage of the pressure ulcer.