Home Health ICD-9/ICD-10 Alert

Question: Mrs. White, an 89-year-old female was admitted to home health following an amputation of the third digit on her left foot due to diabetic vascular disease. She is on insulin for her diabetes, and the physician states that she has a non-healing amputation, and needs wound care. Mrs. White also has a history of hypertension with chronic renal insufficiency, and COPD. Skilled nursing will provide wound care daily as well as teach the caregiver to provide the wound care.

Answer: Code for this patient as follows, says J’non Griffin, RN, MHA, WCC, BCHH-C, HCS-D, COS-C, AHIMA Approved ICD10 Trainer/Ambassador, senior consultant with Home Health Solutions in Carbon Hill, Ala.:

• M1020a: 997.69 (Amputation stump complication; other);
• M1022b: 250.70 (Diabetes with peripheral circulatory disorders; type II or unspecified type, not stated as uncontrolled);
• M1022c: 443.81 (Peripheral angiopathy in diseases classified elsewhere);
• M1022d: 403.90 (Hypertensive chronic kidney disease; unspecified; with chronic kidney disease stage I through stage IV, or unspecified);
  
• M1022e: 585.9 (Chronic kidney disease, unspecified); and
• M1022f: 496 (Chronic airway obstruction, not elsewhere classified).
  
• Other diagnoses: V58.67 (Long-term [current] use of insulin)

You won’t list an aftercare following surgery code for this patient because the physician states this patient has a complication (her non healing amputation), Griffin says.

Your patient’s amputation is complicated by delayed healing. Code for this with the “other” amputation stump complication code, 997.69.

The patient also has hypertension and chronic kidney disease. You can assume these conditions are related, so you’ll sequence hypertension (403) first, followed by chronic kidney disease. Choose a fifth digit for 403 to indicate the stage of the chronic kidney disease. Stages of CKD are according to the glomerular filtration rate (GFR). If the GFR is known then the stage can be determined; if not, you’ll code for it as unspecified.

Your patient’s COPD is unspecified and is not exacerbated. Querying the provider may provide more specific diagnosis, but if no details are forthcoming, list 496.

If you were coding for this patient in ICD-10, Griffin suggests the following codes:

• M1021a: T87.89 (Other complications of amputation stump);
• M1023b: E11.51 (Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene);
• M1023c: I12.9 (Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease);
• M1023d: N18.9 (Chronic kidney disease, unspecified);
• M1023e: J44.9 (Chronic obstructive pulmonary disease, unspecified); and
• M1023f: Z79.4 (Long term [current] use of insulin).

Under ICD-10, the same coding conventions apply, Griffin says. The focus of care continues to be wound care to the non-healing amputation. And many of the other conditions are coded in a similar way.

One exception: The ICD-10 diabetes code is a combination code that encompasses both the Type 2 diabetes and the peripheral angiopathy.