Home Health ICD-9/ICD-10 Alert

Question: One of our patients came to us from the hospital with a pacemaker and total hip replacement. We are caring for both. She originally went to the hospital for the hip replacement and needed to have a pacemaker before the hip replacement could be done. Which one should I code for first? She also has diabetes with hyperglycemia.

Answer: You have two choices of primary diagnosis codes in this case, V58.73 (Aftercare following surgery circulatory system, NEC) and V54.81 (Aftercare following joint replacement). The official coding guidelines state that when two diagnoses both meet the definition of primary diagnosis, you should just choose one. Otherwise you should code the diagnosis requiring the most intensive services. Both of these aftercare codes have status codes that you can also report: V45.01 (Cardiac device in situ; cardiac pacemaker) for pacemaker status and V43.64 (Organ or tissue replaced by other means; joint; hip) for hip joint. But be careful not to fill in the M0240 slots with V codes because you must be sure to include the patient's co-morbidities, such as the heart arrhythmia and the diabetes. Diabetes with hypoglycemia is coded 250.80 (Diabetes with other specified manifestations; type II or unspecified type, not stated as uncontrolled).