Home Health ICD-9/ICD-10 Alert

Question: Our patient was on our service before for aftercare of a total hip replacement (THR). He was discharged after appropriate care. He was readmitted to the hospital with complications of the THR. The joint was removed, and our services were to administer IV antibiotics and provide wound care. The patient then transferred to the hospital for revision of the hip replacement. What diagnosis would I use in M0190 (List each Inpatient Diagnosis and ICD-9-CM code at the level of highest specificity for only those conditions treated during an inpatient facility stay within the last 14 days)? I can't use a surgical code. I'm thinking I'll use 996.47 for other mechanical complication of prosthetic joint implant but I am not sure.

West Virginia Subscriber

Answer: Because your patient required IV antibiotics, he most likely needed a revision due to an infection. List 996.66 (Infection and inflammatory reaction due to internal prosthetic device, implant and graft; due to internal joint prosthesis) in M0190.

Mechanical complications of joint prostheses (996.4x) include loosening, dislocation, periprosthetic fracture and osteolysis among others.

Code 996.66 requires you to also code both the infective organism and the V code indicating the affected joint. If you know the infective organism, add a code from category 041.x (Bacterial infection in conditions classified elsewhere and of unspecified site) in M0190 (and M0210) if the infection wasn't resolved when your patient was readmitted.

Tip: Don't try to put the V43.64 (Organ or tissue replaced by other means; joint; hip) for the joint affected in M0190 and M0210 ...quot; it won't work! Remember, V codes, E codes and surgical codes cannot be placed in M0190 and M0210.

But just because your patient had a complication of the joint and a revision, you won't necessarily have to code the complication in M0230/240 once homecare resumes. If the joint revision was successful, you will use V54.81 (Aftercare following joint replacement) and V43.64 (Organ or tissue replaced by other means; joint; hip) and no longer report the 966 complication code.