Home Health ICD-9/ICD-10 Alert

Question: Our patient was admitted for skilled nursing and physical therapy to address an exacerbation of congestive heart failure (CHF) and declining gait. She also has dementia due to Parkinson's disease and a stage 1 pressure ulcer on her sacrum. How should we code for this patient?

Idaho Subscriber

Answer: List the following codes for this patient, says Judy Adams, RN, BSN, HCS-D, HCS-O with Adams Home Care Consulting in Chapel Hill, N.C.:

• M1020a: 428.0 (Congestive heart failure unspecified);
• M1022b: 332.0 (Parkinson's disease, NOS);
• M1022c: 294.10 (Dementia in conditions classified elsewhere without behavioral disturbance);
• M1022d: 781.2 (Abnormality of gait);
• M1022e: 707.03 (Pressure ulcer; lower back); and
• M1022f: 707.21 (Pressure ulcer, stage I).

Your focus of care is your patient's CHF, so list 428.0 in M1020. Follow this with 332.0 to indicate that she also has Parkinson's disease.

Your patient's dementia is caused by her Parkinson's, so you'll report it with 294.10. The 294.1 (Dementia in conditions classified elsewhere) codes are manifestation codes, so you must "Code first if any underlying physical condition" -- in this case the Parkinson's disease code must precede the dementia code.

Next, because the patient's declining gait was specifically mentioned on the referral and was of particular concern when the therapist evaluated the patient, list abnormal gait, 781.2. Although abnormal gait is generally considered integral to Parkinson's, The AHA Coding Clinic for ICD-9-CM has indicated that it may be added as a separate code, if desired, by the clinician and the coder, Adams says.

In this patient's case, reporting that she has abnormality of gait plus a pressure ulcer has an added benefit because this combination of diagnoses with an OASIS response can earn your agency two additional case mix points in an early episode with 13 or less therapy visits.

Finally, you should list 707.03 to indicate that your patient has a pressure ulcer on her sacrum. When you look up 707.03 in the Tabular list, you'll find that this code for pressure ulcer; lower back has two inclusion notes -- coccyx and sacrum, so you know it's the right code for your patient.

You'll also notice the reminder to "Use additional code to identify pressure ulcer stage (707.20-707.25)" under the 707.0 (Pressure ulcer) category. That means you should sequence 707.21 to indicate a stage I pressure ulcer as your last code in M1022f.