Home Health ICD-9/ICD-10 Alert

Question: We have a patient who had severe bilateral osteoarthritis of the knees and bilateral knee replacements. We have been instructed to provide physical therapy for this patient. How should we code for this?

New Mexico Subscriber

Answer: M0230a: V57.1 (Other physical therapy) 

M0240b: 781.2 (Abnormality of gait)
M0240c: V54.81 (Aftercare following joint replacement)
M0240d: V43.65 (Organ or tissue replaced by other means, joint, knee)
M0245a: 781.2 (Abnormality of gait)

List therapy first because it's the only skilled service being provided. Gait training will most likely be the primary service and abnormality of gait is appropriate to report corrective treatment of an orthopedic condition.

Code the osteoarthritis in M0190/210 but not in M0240 because the affected joints have been replaced. You could still code the osteoarthritis if other joints, such as the hips, were affected and would impact the therapy. 

Don't miss: Note that there is no way to indicate that both knees were replaced in your diagnosis coding. Your surgical procedure would be 81.54 (Total knee replacement).

Unless otherwise indicated, reader questions were answered by Lisa Selman-Holman, JD, BSN, RN, CHCE, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates in Denton, TX.