Home Health ICD-9/ICD-10 Alert

Question: We are providing physical therapy and occupational therapy to a patient who just had a below-knee amputation of his left leg due to peripheral vascular disease secondary to type II diabetes. How should we code for him?


Ohio Subscriber

Answer: You're admitting this patient for rehabilitation services, so you can list V57.89 (Multiple training or therapy) as primary. Code as follows:

• M0230a: V57.89 (Multiple training or therapy);
• M0240b: 781.2 (Abnormality of gait);
• M0240c: 250.70 (Diabetes with peripheral circulatory disorders; type II or unspecified type, not stated as uncontrolled);
• M0240d: 443.81 (Peripheral angiopathy in diseases classified elsewhere);
• M0240e: V49.75 (Lower limb amputation status; below knee); and
• M0245a: 781.2 (Abnormality of gait).

Now, suppose the patient was admitted for aftercare following surgery. In this case, the patient would receive nursing care for assessment, teaching and dressing changes and therapy for the abnormal gait. The same patient would be coded differently and would also earn your agency more points than the 11 gained when the patient was therapy only.

• M0230a: V54.89 (Other orthopedic aftercare);
• M0240b: 250.70 (Diabetes with peripheral circulatory disorders; type II or unspecified type, not stated as uncontrolled);
• M0240c: 443.81 (Peripheral angiopathy in diseases classified elsewhere);
• M0240d: 781.2 (Abnormality of gait);
• M0240e: V58.31 (Encounter for change or removal of surgical wound dressing);
• M0240f: V49.75 (Lower limb amputation status; below knee);
• M0245a: 250.70 (Diabetes with peripheral circulatory disorders; type II or unspecified type, not stated as uncontrolled);
• M0245b: 443.81 (Peripheral angiopathy in diseases classified elsewhere).

Do this: When the ICD-9 codes were updated Oct. 1, 2006, V54.89 was identified as the aftercare code following an amputation. Look under the term "Aftercare," then under "amputation stump" in the alphabetic index, and you'll be directed to V54.89 even though the tabular list at V54.89 doesn't mention amputation care.