Home Health ICD-9/ICD-10 Alert

Question: Our patient was admitted to home health for wound care following a cholecystectomy. His surgical wound is infected with MRSA and cellulitis. How should we code for him?

Kansas 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: 998.59 (Other postoperative infection);
  
• M1022b: 682.2 (Cellulitis; trunk); and
  
• M1022c: 041.12 (Methicillin resistant Staphylococcus aureus).
  

Your focus of care is the infected surgical wound, so you’ll code for this first with 998.59. You won’t use V codes for aftercare or wound care for this patient because the wound is complicated by the infection, Blevins says.

Next, list 682.2 for the cellulitis. An instructional note in the Tabular List of your ICD-9 manual reminds you to also code the organism that caused the cellulitis. In this case, you’ll report 041.12 for MRSA.

Your patient’s gall bladder was removed, so the cholecystitis is resolved and you shouldn’t code for it, Blevins says.

In ICD-10, you would code for this patient as follows:

• M1021a: T81.4xxD (Infection following a procedure, subsequent encounter);
• M1023b: L03.311 (Cellulitis of abdominal wall); and
• M1023c: B95.62 (Methicillin resistant Staphylococcus aureus infection as the cause of diseases classified elsewhere).

Code for the infected surgical wound first with T81.4xxd. You’ll see an instructional note in the Tabular List that reminds you to list an additional code to identify the infection. When ICD-10 requires a seventh character for a code without a full seven characters, you’ll use “x” as a place holder so the seventh character is in the correct place.

Follow T81.4xxd with L03.111 for the cellulitis and finally B95.62 for the MRSA.

Once again, you won’t list any Z codes for aftercare or wound care because the wound is complicated by the infection, Blevins says. And the patient’s gall bladder was removed so the Cholecystitis is resolved and you won’t code for it.

There is no option to code the cholecystitis in M1025 because you didn’t list a Z code. You’ll report the cholecystitis in M1011 so risk adjustment will be obtained there.