Home Health ICD-9/ICD-10 Alert

Question: Our patient had hip joint replacement surgery. The joint has become infected with methicillin-resistant Staphylococcus aureus (MRSA). She also has hypertensive heart and chronic kidney disease (CKD) and congestive heart failure (CHF). How should we code?

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

• 996.66 (Infection and inflammatory reaction due to internal joint prosthesis);

• 041.12 (Methicillin resistant Staphylococcus aureus);

• V43.64 (Organ or tissue replaced by other means; joint; hip);

• 404.91 (Hypertensive heart and chronic kidney disease; unspecified, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified);

• 585.9 (Chronic kidney disease, unspecified); and

• 428.0 (Congestive heart failure, unspecified).

You're coding a complication of the prosthetic joint replacement, Walton says. To find the correct code, turn to the alphabetic index of your ICD-9 manual and look under "Complications," "Infection," "Due to," "Orthopedic," "Joint," "Internal." This sends you to 996.66.

When you look up 996.6 in the Tabular Index, you're instructed to add an additional code to identify specific infection. In this case, that's 041.12 for MRSA, Walton says. As of Oct. 1, you now use this new code to report MRSA and you won't need to list V09.0 (Infection with microorganisms resistant to penicillins).

Code 996.66 also instructs you to add an additional code to identify the infected prosthetic joint -- in this case, that's V43.64 for the prosthetic hip joint, Walton says.

You'll need documentation connecting the heart disease with the hypertension before you can use a 404.xx combination code in this situation. If you have that documentation, then you can list 404.91, which includes heart and chronic kidney disease due to hypertension.

Follow the instructions under category 404.xx to add an additional code for the type of heart failure and the instructions in the fifth digit box for choosing correct fifth digit, Walton says.

And finally, add an additional code to indicate the stage of CKD.