Home Health ICD-9/ICD-10 Alert

Question: Our patient fell and broke her hip. At the hospital she underwent left hip hemiarthroplasty. We are providing aftercare as well as physical and occupational therapy. She has a peg tube but is not receiving nourishment from it. We are just flushing it at this time. She is also on Lovenox daily for 21 days postoperatively for deep vein thrombosis prophylaxis. How should I code for her?

-- Oklahoma Subscriber

Answer: Hemiarthroplasty is a surgical procedure that replaces one-half of the joint with an artificial surface and leaves the other part in its natural (pre-operative) state, says Vonnie P. Walton, HCS-D, coding and billing specialist for Excellence Health Care Inc. in Houston. For this patient, list the following codes:

Your patient had a partial joint replacement to repair the hip fracture so you wouldn't list the aftercare of fracture code in M0230/240, Walton says. And aftercare following joint replacement is more specific to the reason you're providing aftercare.

Don't repeat the acute fracture code in M0240 because acute fracture codes are reserved for the acute setting. The fracture code may go in M0246 because it is a case mix code. Listing the acute fracture code in M0246 will also result in risk adjustment for outcomes.

The acute fracture code is still considered a pertinent diagnosis, so it must appear on the Plan of Care according to Chapter 8 of the OASIS manual, Walton says.

You will also need to list the code that identifies the specific joint replaced as directed by the coding manual, Walton says. Therapy usually focuses on abnormal gait and safety so you should address these diagnoses as well if they are pertinent.

Report V58.61 for the anticoagulant use because the drug is being used for prophylactic purposes. If PT/INR labs are being drawn, then you should also report V58.83 (Encounter for therapeutic drug monitoring), sequenced before V58.61. Also list V55.1 to indicate that you are monitoring and flushing the G tube.