Home Health ICD-9/ICD-10 Alert

Question: Our patient has a history of prostate cancer with metastasis to the right femur. He has a pathologic fracture of the right femur with routine healing. We will be providing therapy and nursing for observation and assessment, strengthening, transfers, and pain management related to the cancer. He is taking morphine for the pain. How would we code for this patient in ICD-10?

Answer:  Code for this patient as follows, says Lisa Selman-Holman, JD, BSN, RN, COS-C, HCS-D, HCS-O, AHIMA Approved ICD-10-CM Trainer/Ambassador of Selman-Holman & Associates, LLC, CoDR—Coding Done Right and Code Pro University in Denton, Texas.

• M1021a: M84.551D (Pathological fracture in neoplastic disease, right femur; subsequent encounter for fracture with routine healing);
• M1023b: C79.51 (Secondary malignant neoplasm of bone);
• M1023c: G89.3 (Neoplasm related pain [acute] [chronic]);
• M1023d: Z85.46 (Personal history of malignant neoplasm of prostate); and
• M1023e: Z79.891 (Long term [current] use of opiate analgesic).

Your focus of care for this patient is his pathologic fracture. You’ll code for this with M84.551D. This single code indicates the site of the pathologic fracture as well as the fact that it was caused by the patient’s cancer. 

You’ll see a note at the M84 category that advises “Code also underlying neoplasm.” Remember the “code also” convention means you’ll need to code for both conditions, but they may be sequenced either way. So, if the neoplasm was the focus of care, you would code the secondary malignant neoplasm of bone followed by the pathological fracture.

Your next code for this patient is C79.51 to indicate that his fracture was caused by the bone cancer in his right femur.

You are providing care for the pain he experiences as a result of the cancer, so it’s appropriate to list G89.3 next. Follow this with Z85.46 to indicate his history of prostate cancer.

Finally, report Z79.891 to document his morphine use.