Home Health ICD-9/ICD-10 Alert

Question: Our patient has multiple fractures: wrist, pelvis, nasal, hip and ankle due to a motor vehicle accident. He had an ORIF for the hip fracture. He is 20 years old with no other health problems prior to the accident. We are providing skilled nursing and physical therapy. How should I code for him? Can I put an acute fracture code in M0246 for case mix points?

Answer: M0246 applies only to patients who have Medicare PPS as the payer (or another payer that requires an HHRG). It's not likely that your 20-year-old patient is a Medicare patient, so there is no requirement or advantage to placing the fracture codes in M0246.

In this case, use the aftercare fracture codes:

• V54.12 (Aftercare for healing traumatic fracture of lower arm) for the wrist;

• V54.19 (Aftercare for healing traumatic fracture of other bone) for the nasal and pelvis fractures;

• V54.15 (Aftercare for healing traumatic fracture of upper leg) for the hip; and

• V54.16 (Aftercare for healing traumatic fracture of lower leg) for the ankle.