Home Health ICD-9/ICD-10 Alert

Question: Our new patient had a total hip replacement. We are providing medication monitoring for his Coumadin, teaching wound care to his wife, and performing physical therapy for gait abnormality. Skilled nursing will make a few visits, but physical therapy will make up the bulk of the visits. How should I code for this patient?

Answer: You might be tempted to list V57.1 (Other physical therapy) for this patient because therapy is providing most of the care, but when you have multiple disciplines involved with a patient, it's best not to use a V57.x category code.

For this patient, list these codes instead:

• M0230a/M1020a: V54.81 (Aftercare following joint replacement)

• M0240b/M1022b: V43.64 (Organ or tissue replaced by other means; hip)

• M0240c/M1022c: 781.2 (Abnormality of gait)

• M0240d/M1022d: V58.83 (Encounter for therapeutic drug monitoring)

• M0240e/M1022e: V58.61 (Long term use of anticoagulants).

Aftercare is the focus of care for both nursing and physical therapy for your patient's hip replacement surgery, so you should choose V54.81 as your principal diagnosis code.

Notes following the entry for V54.81 in your coding manual advise you to list an additional code to specify the joint replaced, so you'll list V43.64 to specify the hip joint as a secondary diagnosis. You don't need to sequence the code you list to indicate the joint replaced immediately following the joint replacement code.

Finally, list 781.2 to describe the issue your physical therapist is treating.