Home Health ICD-9/ICD-10 Alert

Question: We see many patients for therapy and nursing who have had joint replacements secondary to degenerative joint disease (DJD). We don't report abnormality of gait in M0245 unless the underlying medical diagnosis is a case mix diagnosis such as a fracture code or one of the other orthopedic case mix codes. We don't report abnormality of gait in M0245 for a DJD diagnosis unless physical therapy is primary. Are we coding correctly for these patients?


California Subscriber

Answer: When you are providing both therapy and nursing aftercare for joint replacement surgery, aftercare is the most intense service and should be listed as primary. Report V54.81 (Aftercare following joint replacement) as primary for these patients.

With joint replacement, however, you can still place 781.2 (Abnormality of gait) in M0245 for payment. Use abnormality of gait when the gait problem is related to a neurological problem, an orthopedic problem after corrective treatment or an amputation.

Abnormality of gait is not an appropriate diagnosis for a patient with arthritis, frequent falls, a medical problem resulting in de-conditioning or when a definitive diagnosis is known. Abnormality of gait is a symptom code and the coding guidelines instruct that when a definitive diagnosis is known, you wouldn't ordinarily report a symptom code.

The exception to this guideline occurs when the care is focused on only one aspect of the condition represented by the definitive diagnosis. For example: you are only providing gait training to the patient.