Home Health ICD-9/ICD-10 Alert

Question: One of our patients came to us from the hospital with a pacemaker and total hip replacement. We are caring for both. She originally went to the hospital for the hip replacement and needed to have a pacemaker before the hip replacement could be done. Which one should I could for first? She also has diabetes with hyperglycemia.

North Carolina Subscriber

Answer: Your primary diagnosis depends on the most acute condition requiring the most intensive care. You have to decide your chief reason for admission to home care. If the aftercare of the hip replacement is primary, code like this:

• M0230a: V54.81 (Aftercare following joint replacement);

• M0240b: V43.64 (Organ or tissue replaced by other means; joint; hip);

• M0240c: 781.2 (Abnormality of gait);

• M0240d:V58.73 (Aftercare following surgery of the circulatory system, NEC);

• M0240e: 250.00 (Diabetes mellitus without mention of complication; type II or unspecified type not stated as uncontrolled); and

• M0240f: V45.01 (Cardiac device in situ; cardiac pacemaker).

You didn't state the condition that required the pacemaker, and since the pacemaker doesn't "cure" the conditions it treats, you should code for that condition as well. Although new guidance from Med-icare indicates to avoid excessive use of V codes, in this case the conditions treated by the surgery are not appropriate to describe the care you are providing. V codes are appropriate when caring for the patient during the recovery phase.

You can place the condition treated with the joint replacement across from V54.81 if it is a case mix diagnosis.

Note: Scenario 2 in the newly revised Attachment D incorrectly codes the osteoarthosis as a current condition after the joint replacement. The osteoarthosis should be coded only if the OA still exists in the other joints.