Home Health ICD-9/ICD-10 Alert

Question: We have a patient who had a joint replacement some time ago. He was referred to our agency with an infected knee replacement (MRSA) to receive IV antibiotics for five weeks. The patient says that the doctor will do another knee replacement after that. How should we code for him now, and will our coding change when he comes back on service later?

Vermont Subscriber

Answer: For this patient, list the following codes:

• M0230a: 996.66 (Infection and inflammatory reaction due to internal prosthetic device, implant and graft; due to internal joint prosthesis);

• M0240b: 041.11 (Staphylococcal aureus);

• M0240c: V09.0 (Infection with microorganisms resistant to penicillins);

• M0240d: V43.65 (Organ or tissue replaced by other means; joint; knee);

• M0240e: V58.81 (Fitting and adjustment of vascular catheter); and

• M0240f: V58.62 (Long-term [current] use of antibiotics).

To find the code for the infected joint prosthesis, first reference the term "complications" in the alphabetic index of your ICD-9 manual. Next, locate the subterm "infection and inflammation" and then you'll find the "joint prosthesis" code (966.66).

Don't miss: Under the subcategory 996.6 you will find an instruction to use an additional code to identify the infection, so if you know the organism causing the infection, you should code it. Because the infection is resistant, you also need to add a code for the resistance. Those codes are found under the term "resistance" in the alphabetical index.

There is also an instruction under the 996.66 code to use an additional code to identify the affected joint, in this case V43.65.
Once the infection clears, if the patient has a revision, then you would code for it as any other joint replacement with V54.81 (Aftercare following joint replacement) for the aftercare. Never code the V code as primary when you are dealing with a complication.