Home Health ICD-9/ICD-10 Alert

Question: Our patient had hip joint replacement surgery. The joint has become infected with methicillinresistant Staphylococcus aureus (MRSA). She also has hypertensive heart and chronic kidney disease (CKD) and congestive heart failure (CHF). How should we code  for her?

Answer: List the following codes for this patient:

• 996.66 (Infection and inflammatory reaction due to internal joint prosthesis);

• 041.12 (Methicillin resistant Staphylococcus aureus);

• V43.64 (Organ or tissue replaced by other means; joint; hip);

• 404.91 (Hypertensive heart and chronic kidney disease; unspecified, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified);

• 585.9 (Chronic kidney disease, unspecified); and

• 428.0 (Congestive heart failure, unspecified).

You're coding a complication of the prosthetic joint replacement, so to find the correct code, look under "Complications," "Infection," "Due to," "Orthopedic," "Joint," "Internal" in the alphabetic index of your ICD-9 manual. This directs you to 996.66.

When you look up 996.6 in the tabular Index, you'll find that you must add an additional code to identify specific infection. In this case, that's 041.12 for MRSA. Code 996.66 also requires you to add an additional code to identify the infected prosthetic joint -- in this case, that's V43.64 for the prosthetic hip joint.

You must have documentation that connects the heart disease with the hypertension before you can use a 404.xx combination code for your patient. If you have that documentation, then you can list 404.91, which  includes heart and chronic kidney disease due to hypertension.

Follow the instructions under category 404.xx to add an additional code for the type of heart failure and the instructions in the fifth digit box for choosing correct fifth digit. And finally, add an additional code to indicate the stage of CKD.