Home Health ICD-9/ICD-10 Alert

Question: Our patient has an infected cat bite of the hand. She also has cellulitis, congestive heart failure (CHF) and coronary artery disease. We are providing wound care and antibiotics via PICC line. How should we code for her?

-- North Carolina Subscriber

Answer: Code for this patient as follows, suggests Judy Adams, RN, BSN, HCS-D, with LarsonAllen in Charlotte, NC.

• M0230a: 882.1 (Open wound of hand except finger[s] alone; complicated);

• M0240b: 682.4 (Other cellulitis and ab-scess; hand, except fingers and thumb);

• M0240c: 428.0 (Congestive heart failure, unspecified);

• M0240d: 414.00 (Coronary atherosclerosis; of unspecified type of vessel, native or graft);

• M0240e: V58.81 (Fitting and adjustment of vascular catheter); and

• M0240f: E906.3 (Bite of other animal ex-cept arthropod).

Wound care of the infected trauma wound is the focus of your care, so this is your principal diagnosis. Remember to indicate the complication with fourth digit "1."

Next, list the cellulitis, followed by her other co-morbidities -- CHF and CAD. If you know the organism that caused the infection, you should list it as well following the open wound of the hand.

Follow these codes with V58.81 to indicate the use of an IV.

Listing an E code for the cause of the wound is optional but provides additional detail. This scenario would garner case mix points for three diagnoses -- the open wound as primary (skin 1), cellulitis (skin 2), and either the CHF or the CAD diagnosis since these are both from the same category.