Home Health ICD-9/ICD-10 Alert

Question: We have a patient whose lung cancer has metastasized to the bone, and as a result, she has suffered a pathologic fracture of her upper humerus, which required her to have pins placed surgically. Should we report a code for aftercare for healing pathologic fracture, a code for aftercare for neoplasm, or can we list both?

Kentucky Subscriber

Answer: Your patient had surgery because of a pathologic fracture, so report the code for aftercare for healing pathological fracture, V54.21. The surgery was not performed for the purpose of treating the cancer itself, so you should not report V58.42 (Aftercare following surgery for neoplasm).

If the aftercare for the fracture is the focus of the care, code for your patient like this:

• M0230a: V54.21 (Aftercare for healing pathologic fracture of upper arm);

• M0240b: 198.5 (Secondary malignant neoplasm of other specified sites; bone and bone marrow); and

• M0240c: 162.9 (Malignant neoplasm of trachea, bronchus, and lung; bronchus and lung, unspecified).

In this case, sequence the secondary site of the cancer before the primary site of the cancer because the metastasis to the bone will have a larger impact.