Home Health ICD-9/ICD-10 Alert

Question: Our patient has a diagnosis of internal dehiscence of an infected vein graft site that failed. We will be providing wound care. How should we code for her?

Ohio Subscriber

Answer: List the following codes for this patient, says Tarboro, N.C.-based coding and billing specialist Vonnie P. Blevins, HCS-D, HCS-O, COS-C, BCHH-C.

• M1020a: 998.31 (Disruption of internal operation [surgical] wound);
• M1022b: 996.62 (Infection due to other vascular device, implant, and graft); and
• M1022c: 996.1 (Mechanical complication of other vascular device implant, and graft).

Before coding for this patient, make certain that the complications have been verified with the physician, Blevins says. That done, look in the alphabetic index to find your codes. Start your search for the dehiscence with “disruption,” “wound,” “operation,” “internal.” Try “complications,” “vascular,” “device, implant, or graft,” “infection or inflammation” to find the infection code. And look under “complications,” “vascular,” “device, implant, or graft,” “mechanical” to indicate that the graft site failed. Next, verify your target codes in the tabular list.

Remember: You should only use 998.xx (Other complications of procedures, not elsewhere classified) codes when a more specific code is not available, Blevins says. For example, 996.62 is a better choice for describing your patient’s infection than 998.59 (Other postoperative infection) because 996.62 is more specific about what caused the infection.

Caution: It’s not appropriate to list a V code like V58.31 (Encounter for change or removal of surgical wound dressing) for wound care with this patient because his wound is complicated. As a general rule, V codes are not appropriate when treatment is directed at a current, acute disease or injury.

ICD-10: If you were coding for this patient under ICD-10, you would list the following codes, Blevins says:

• T81.32xD (Disruption of internal operation [surgical] wound, not elsewhere classified; subsequent encounter);
• T82.7xxD (Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts; subsequent encounter); and
• T82.318D (Breakdown [mechanical] of other vascular grafts; subsequent encounter).

Good news: To find T81.32xD, you’ll follow the same alphabetic index search terms as you did in ICD-9. Finding T82.7xxD takes a slightly different path than it did in ICD-9. Look under “infection,” “device, implant or graft,” “vascular.” And, to find T82.318D, look under complications,” “vascular,” “graft,” “mechanical,” “breakdown,” “specified vessel NEC.”

Tip: You’ll see a note to list an additional code to identify the infection under T82.7xxD. If you know the organism that caused your patient’s infection, you can include another code to report those specifics.