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Home Health ICD-9/ICD-10 Alert

YOU BE THE CODER:

GATHER DETAILS FOR COPD CASE MIX POINTS

Published on Mon Oct 26, 2009

Question: Your 82-year-old patient lives alone and has a history of falls. He was admitted to home care for severe pain due to osteoarthritis in bilateral knees. You will be providing physical therapy and skilled nursing. He also has a history of diabetes with numbness and tingling to bilateral lower extremities, which the physician has confirmed is diabetic neuropathy. He also has hypertension (HTN).

Upon reviewing the patient's medication, the nurse finds two inhalers with recent start dates. Checking with the physician, she finds that they are for asthma with chronic obstructive pulmonary disease (COPD). How would you code for this patient?

-- Vermont Subscriber

Answer: List the following codes for this patient, says Cherlynn Taylor, senior coding coordinator with The National Coding Center in Troy, Mich:

M0230/M1020a: 715.36 -- Osteoarthrosis, localized, not specified whether primary or secondary; lower leg

M0240/M1022b: 250.60 -- Diabetes mellitus with neurological manifestations; type II or unspecified type, not stated as uncontrolled

M0240/M1022c: 357.2 --  Polyneuropathy in diabetes

M0240/M1022d: 493.20 -- Chronic obstructive asthma; unspecified

M0240/M1022e: 401.9 -- Essential hypertension; unspecified

M0240/M1022f: V15.88 -- History of fall.

Your primary focus of care is the patient's osteoarthrosis, so list this code first.

Follow this with 250.60 for diabetes with neurological manifestations and then list the manifestation code for diabetic neuropathy as indicated by manifestation coding guidelines, Taylor advises. Next, list the asthma with COPD and HTN because these chronic conditions will always impact the care you provide and you should report them.

Case mix points are available for asthma with COPD.

Get it in writing: If these case mix diagnoses were not assessed, documented, and clarified with the physician, you won't have consistent and complete documentation, Taylor says. And you also won't receive the appropriate reimbursement for the care you provide.

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