Home Health ICD-9/ICD-10 Alert

Question: Think you have V codes down pat? Try coding these scenarios from Shirley Kucirek, HCS-D with Acorn's End Training & Consulting in Rice Lake, Wis. to see whether you need to do some brushing up. How would you code for these patients?

Scenario 1: Your patient had a left total knee replacement due to severe osteoarthritis in his left knee. Nursing is ordered for wound care.

Scenario 2: Your patient had a left total knee replacement due to severe osteoarthritis in his left knee. The wound is infected with Staph aureus due to the joint prosthesis. Nursing is ordered.

Scenario 3: Your patient fell at home and fractured her femur. As a result she had a total hip replacement. She also has degenerative joint disease. Physical therapy is ordered.

Scenario 4: Your patient was diagnosed with Lyme disease and has a new PICC line. Nursing is ordered. Try coding these scenarios before turning to page 54 to see the codes Kucirek recommends.

Scenario 1 Answer:

You are providing aftercare following your patient's joint replacement surgery, so V54.81 is the appropriate principal diagnosis. The surgery corrected the osteoarthritis in his knee, so you can list this resolved condition (715.36) in M1024a for potential case mix points. Osteoarthritis is considered localized when only one site is mentioned. The site can be bilateral and still be considered localized.

Additional V codes indicate which joint was replaced (the knee) and that you will be providing attention to his wound dressing.

• M1020a: 996.66 (Infection and inflammatory reaction due to internal joint prosthesis);
• M1022b: 041.11 (Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site); and
• M1022c: V43.65 (Organ or tissue replaced by other means; joint; knee).

You are caring for your patient post-surgery, but the presence of a complication means you cannot list an aftercare V code. Instead, list 996.66 to report the infected joint prosthesis as the principal diagnosis.

Follow this with 041.11 to further specify the infection, and status V code V43.65 to report the joint affected.

Scenario 3 Answer:

List V57.1 as your principal diagnosis to indicate this is a therapy-only case.

Next, indicate that your therapist is seeing the patient for aftercare following his joint surgery by listing V54.81. The joint replacement resolved a fractured hip, so you can list 821.00 in M1024b for potential case mix points.

Additional codes report that your patient has osteoarthrosis (715.90) which will impact the care you provide, and specify that the patient's hip joint was replaced (V43.64).

• M1020a: 088.81 (Lyme Disease) and
• M1022b: V58.81 (Fitting and adjustment of vascular catheter).

You are providing care for your patient's Lyme disease in this scenario. Following the principal diagnosis with V58.81 offers more detail about the care you will give.