Home Health ICD-9/ICD-10 Alert

Published on Wed May 28, 2008 PDF

Question: Our patient fractured his hip and had a hip replacement. We are providing nursing for aftercare and physical therapy to address gait abnormality. What should I use for a primary diagnosis? Can I list the V57.1 (Other physical therapy) code in M0240? If not, how do I indicate that the patient is receiving physical therapy?

-- South Dakota Subscriber

Answer: For this patient, list the following codes, says Vonnie P. Walton, HCS-D, coding and billing specialist for Excellence Health Care Inc. in Houston.

M0230/M0240

V54.81 (Aftercare follow-ing joint replacement) 781.2 (Abnormality of gait) V43.64 (Organ or tissue replaced by other means; joint; hip)

820.8 (Fracture ofneck of femur;unspecified part of neck of femur, closed)

Both nursing and therapy are seeing the patient for aftercare related to the joint replacement, so aftercare of the joint replacement is the primary diagnosis code, Walton says.

You wouldn't use the V code for physical therapy because this is not an encounter for therapy only, Walton says. You are showing the symptom left from the injury and the aftercare that therapy will be providing -- the abnormal gait and aftercare for the joint replacement.

Also the OASIS M0826 (Therapy need) and your documentation will show that the patient does need and is getting physical therapy. The CPT codes for therapy are on your final claim, and that is how you are paid for your therapy visits. Code V57 has nothing to do with payment in this scenario.