Home Health ICD-9/ICD-10 Alert

Question: How would you code the following scenario to capture both fracture diagnoses? Our new patient has a wrist fracture (814.00) and a fractured right orbit (802.8). Aftercare for other bone (V54.19) applies to both of these bone fractures. Would you use V54.19 twice and place 814.00 and 802.8 in M0246 (column 3) or would you use V54.19 once and place one fracture code in M0246 Column 3 and one fracture code in Box 21?

Answer: The same code can only be used once, so use V54.19 (Aftercare for healing traumatic fracture of other bone). Place one of the fracture codes in M0246 column 3 directly across from the V code. Do not use column 4 for the second fracture code because column 4 is reserved for conditions requiring multiple codes and doesn't apply in this case. Include both fracture codes on the plan of care to be compliant with the Conditions of Participation because the Centers for Medicare & Medicaid services still considers the fractures pertinent diagnoses.