Home Health ICD-9/ICD-10 Alert

Question: Our patient was admitted to home health for wound care to a Stage IV pressure ulcer to the heel. The pressure ulcer is infected with MRSA and osteomyelitis. Skilled nursing will be administering IV antibiotics and flushing catheter. How should we code for this patient?

Florida Subscriber

Answer: List the following codes for this patient, says Mary Deakle, HCS-D, COS-C, manager of compliance and education with Daymarck Home Healthcare Coding in Bismarck, N.D.

• M1020a: 707.07 (Pressure ulcer; heel);
• M1022b: 707.24 (Pressure ulcer; stage IV);
• M1022c: 730.27 (Unspecified osteomyelitis; ankle and foot);
• M1022d: 041.12 (Methicillin resistant Staphylococcus aureus);
• M1022e: V58.81 (Fitting and adjustment of vascular catheter); and
• M1022f: V58.62 (Long-term [current] use of antibiotics).

You’ll notice that there is no one specific code that indicates an infected pressure ulcer. Instead, you’ll begin by listing codes for the pressure ulcer’s location (707.07) and stage (707.24).

Next, you can report the additional details you have regarding the pressure ulcer. When you look up the code for osteomyelitis in the tabular list of your coding manual, you’ll find a note at the category level asking you to "Use additional code to identify organism, such as Staphylococcus (041.1)." So, proper sequencing for these diagnoses is to list the osteomyelitis first (730.27), followed by the MRSA (041.12).

Finally, list the V codes that describe your patient’s IV antibiotic care, V58.81 and V58.62.