Home Health ICD-9/ICD-10 Alert

Question: The patient is admitted to home care following an accident that left him with a comminuted spiral fracture of the left femur. He had an open reduction of the fracture and developed a postoperative infection. He is receiving Ampicillin IV via a PICC line. The patient is taking Coumadin because of a deep venous thrombosis in his right calf during hospitalization. He also has a recent history of prostate cancer. His wife gives the Ampicillin and changes the surgical dressing. The nurse draws labs and changes the PICC dressing every week. No physical therapy is ordered. How would you code this episode?

Answer: Because the patient developed a postoperative infection, you would not use an aftercare code such as V58.43 (Aftercare following surgery for injury and trauma) as primary, explains Laresa Boyle director of coding services at Longview, TX-based Healthcarefirst. You don't use an aftercare code if a complication such as a postop infection or a wound dehiscence is the focus of care. Instead, code 998.59 (Other postoperative infection) as primary in M0230, she recommends.

Then in M0240, Boyle would code V58.81 (Fitting and adjustment of vascular catheter) for the PICC line care, V58.62 (Long term [current] use of antibiotics), V12.51 (Personal history of certain other diseases, diseases of the circulatory system) for the earlier DVT, V58.83 (Encounter for therapeutic drug monitoring), V58.61 (Long term [current] use of anticoagulants) and V10.46 (Personal history of malignant neoplasm, prostate).