Home Health ICD-9/ICD-10 Alert

Question: Our seventy-four-year-old patient was involved in a motor vehicle accident and suffered a head injury. When the patient had sufficiently recovered from the acute injuries, she was transferred to home health for further physical therapy, speech therapy, and nursing. As a result of her intracerebral injury, she has significant problems with dysarthria, oral dysphagia for which a gastrostomy has been placed and generalized muscle weakness. How should we code for her?

Answer: List the following codes for this patient:

• M1020a: 784.51 (Dysarthria);
• M1022b: 787.21 (Dysphagia, oral phase);
• M1022c: 728.87 (Muscle weakness [generalized]);
• M1022d: 907.0 (Late effect of intracranial injury without mention of skull fracture);
• M1022e: V55.1 (Attention to gastrostomy); and
• M1022f: E929.0 (Late effects of motor vehicle accident).

You're providing care for late effects of your patient's motor vehicle accident, so you must be familiar with correct late effects sequencing.

The general rule, when coding for late effects, is to list the residual deficit first, followed by the late effects code. There are some exceptions to this rule, such as when you are coding for a manifestation as a late effect or for the late effect of a cerebrovascular accident, but in your patient's case, the general rule is the one you need to follow.

As you describe your patient's condition, her dysarthria seems to be the main focus of care, so list this in M1020. Next, list the code for your patient's dysphagia.

You have the detail that this condition is oral phase, so be sure to list the specific code (787.21). Follow this with 728.87 for generalized muscle weakness.

Now that you have listed all of your patient's late effects, it's time to report a code to indicate what caused them -- in this case, 907.0 for her head injury.

Next, list the V code for attention to gastrostomy. And finally, you can list an E code to further describe the circumstances of your patient's injury which caused the late effects. This is optional in home health coding, but does provide more detail. Because the E code indicates the initial injury was the result of the auto accident, be sure to add an explanation regarding payor sources in the remarks section of your claim.