Home Health ICD-9/ICD-10 Alert

Question: Our new patient had hip replacement surgery. The joint has become infected with methicillin-resistant Staphylococcus aureus (MRSA). Which codes should I report for him?

-- West Virginia Subscriber

Answer: For this patient, list the following codes, says Vonnie P. Walton, HCS-D, coding and billing specialist for Excellence Health Care Inc. in Houston, TX.

• 996.66 (Infection and inflammatory reaction due to internal joint prosthesis);

• 041.11 (Staphylococcus aureus);

• V09.0 (Infection with microorganisms resistant to penicillins); and

• V43.64 (Organ or tissue replaced by other means; joint; hip).

You might be tempted to code 998.59 (Other postoperative infection) in this situation, Walton says. This diagnosis would score case mix points, but it would also be upcoding, she says. If you read the "excludes" notes under 998.5 you'll see that this code excludes 996.60-996.69 (Infection and inflammatory reaction due to internal prosthetic device, implant, and graft).

To code this scenario properly, turn to the alphabetic index and look under "complications, infection, joint prosthesis, internal," Walton says. This leads you to 996.66. Then verify your code in the tabular index -- this is where you get all of your additional information, she says.

Usually with complications you don't use V codes, but this case is an exception. Under 996.66, the coding manual instructs you to use an additional code to identify the infected prosthetic joint. (V43.60-V43.69). And under 996.6, you're asked to use an additional code to identify specified infections, in this case MRSA.

You should also add any additional codes for conditions you may be addressing or comorbidities such as 781.2 (Abnormality of gait), V58.83 (Encounter for therapeutic drug monitoring) or V58.61 (Long-term [current] use of anticoagulants).

Note: Beginning Oct. 1, 2008, the code for MRSA is 041.42 in this scenario and you'll no longer report the V09.0 code.