Home Health ICD-9/ICD-10 Alert

Answer:

Code for this patient as follows, says Trish Twombly, BSN, RN, HCS-D, CHCE, COS-C, director of coding with Foundation Management Services in Denton, Texas.

Your focus of care is aftercare for the patient's heart surgery, so you'll list an aftercare V code in M1020. You'll know that V58.73 is the correct aftercare code because it covers conditions classifiable to 390-459, and aortic stenosis (424.1) falls in this range.

It's not appropriate to report the aortic stenosis code in M1022, however, because the valve replacement surgery has corrected this condition. And it would not be placed in M1024 across from the V code because it is not a case mix code.

Next, you'll list co-morbidities that coexisted at the time the plan of care was established or which developed subsequently or conditions that affect the treatment or care, Twombly says. Remember you should include not only conditions actively addressed in the patient's plan of care but also any co-morbidity affecting the patient's responsiveness to treatment and rehabilitative prognosis -- even if the condition is not the focus of any home health treatment itself.

These include the UTI, COPD, depression, and dementia. Be sure that the documentation indicates the care you will provide for the UTI and COPD, as well as the ways in which the depression and dementia impact the care.

Finally, list V43.3 to indicate that the patient had her heart valve replaced.

Tip: Because aortic stenosis (424.1) neither fits case mix nor meets Appendix D criteria, the code should not be listed in M1024, Twombly says. Also, aortic stenosis is ineligible to be listed in M1010 and M1016 because the look back for those data elements is fourteen days. In this scenario, aortic stenosis will not be an eligible risk factor in the risk adjustment equation that ultimately affects your outcome data.