Home Health ICD-9/ICD-10 Alert

Question: I've heard that I should code congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD) patients who are receiving both skilled nursing and physical therapy in the home with 428.0 (Congestive heart failure, unspecified) or 496 (Chronic airway obstruction, not elsewhere classified) as primary in M0230 and then 728.87 (Muscle weakness [generalized]) as secondary no matter the frequency. Should I code for patients with cancer or heart conditions the same way?


North Carolina Subscriber

Answer: The sequencing of your diagnoses depends on the focus of home care. To determine what should be sequenced first, don't consider the frequency of visits--consider the conditions to be treated.

For example, it would be difficult to substantiate the muscle weakness diagnosis as primary if your patient was in an acute phase of congestive heart failure or decompensated COPD. But if the patient had been diuresed after her exacerbation of CHF, and the weakness that resulted was the primary reason for home care, muscle weakness could be sequenced first.

Crucial: Certain intermediaries consider the weakness associated with cardiac and respiratory diagnoses as general weakness (780.79), and not muscle weakness (generalized) (728.87). Documentation is the key to supporting the diagnosis code you report.