Which codes would you choose for these patients? Make your selections before reading on to see the codes our expert recommends. Scenario 1:
Scenario 2:
Mrs. K. is another diabetic patient on care. The home health nurse gives her daily insulin injections because she is unable to self inject and is in a dementia living facility due to episodes of wandering from the assisted living apartments. She has current diagnoses of Alzheimer's disease with dementia with behavior disturbance. How would you code for this patient?Scenario 3:
Mrs. M. has documented dementia with Parkinsonism. She will be receiving physical therapy only for abnormal gait. How would you code for this patient?Scenario 1 Answer:
Code for this patient as follows, says Jan McLain, RN, BS, LNC, HCS-D, COS-C, with Adventist Health System Home Care in Port Charlotte, Fla.:The focus of care is your patient's diabetes. While the diabetes was uncontrolled when he was admitted to the hospital, it's not stated as uncontrolled on the home health referral, so 250.00 is the principal diagnosis.
Your patient has a dementia diagnosis, but no indication of an underlying etiology or behavioral disturbance or, so you list 294.20 for this diagnosis.
Next, list 414.00 for his CAD, the status to indicate his bypass and follow this with V58.67 to indicate that he is taking insulin. Finally, report V54.81 to show that he has had a bypass graft.
Scenario 2 Answer:
Code for this patient as follows, says McLain:The focus of care is your patient's diabetes. Her diabetes isn't uncontrolled and she has no manifestations, so 250.00 is the principal diagnosis.
Your patient has a diagnosis of dementia due to Alzheimer's disease. So you'll need to sequence the underlying etiology first (Alzheimer's), followed by the appropriate dementia diagnosis.
This patient does have a history of behavioral disturbance -- wandering in her case. So, you'll choose 294.11 for the dementia and follow this with V40.31 to indicate wandering.
Finally, list V58.67 to indicate that she is taking insulin.
Scenario 3 Answer:
Code for this patient as follows, says McLain:This is a physical therapy-only case, so your primary diagnosis is V57.1. Physical therapy is addressing the patient's abnormal gait, so list 781.2 next.
Next, list 331.82 to indicate that the patient has Dementia with Lewy bodies also known as Parkinsonism. Therapy is addressing a symptom of the Parkinsonism, but this disease affects the plan of care. The neurological impact of Parkinsonism makes the therapy approach much different from that of a knee replacement patient with abnormality of gait.
Finally, list 294.10. Listing a second dementia code when dementia is included in the Parkinsonism code allows you to indicate whether behavior disturbances are present, McLain says.
Note:
Parkinson's with dementia is coded with 332.0/294.10 and Parkinsonism with dementia is coded with 331.82/294.10. Look carefully at the physician's documentation. Sometimes physicians use these terms interchangeably but you should try to nail down which condition they think the patient really has, says Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, HCS-O, consultant and principal of Selman-Holman & Associates and CoDR -- Coding Done Right in Denton, Texas.