Home Health Coding and OASIS Expert

The ICD-10 deadline may have been extended, but the transition is still in the works. Consider what your coding should look like in the following situation — now and after the switch to ICD-10.

Your patient was admitted to home care for management of her congestive heart failure (CHF) and to teach her caregivers about her Parkinson’s disease as well as her physician-documented dementia that is due to Parkinson’s disease. She also wanders from home, and is not safe without supervision. How would you code for this patient?

In ICD-9, you would list the following codes for this patient, says Judy Adams, RN, BSN, HCS-D, HCS-O, with Adams Home Care Consulting in Asheville, N.C.:

• M1020a: 428.0 (Congestive heart failure, unspecified);
• M1022b: 332.0 (Parkinson’s disease);
• M1022c: 294.11 (Dementia in conditions classified elsewhere with behavioral disturbance); and
• M1022d: V40.31 (Wandering in diseases classified elsewhere).

Your primary focus of care for this patient is management of her congestive heart failure. The physician has documented her dementia due to Parkinson’s disease, and this condition is likely to impact the care your agency will provide since the patient may not remember to check her weight daily or follow her treatment regimen for her CHF, so it’s appropriate to list a code for this psych condition. 

Her physician also wants the skilled nurse to monitor the patient’s dementia and notify him if it is getting worse so that he may adjust her treatment as needed. Due to the dementia, you will have to be sure that all of your teaching on the CHF, Parkinson’s disease, and dementia is targeted to the caregiver. 

You’ll also list an additional code to indicate her wandering because this behavior isn’t inherent in dementia and puts the patient at a higher risk for injuries or getting out of the home and then lost.

To code for this patient in ICD-10, you would list the following codes:

• M1021a: I50.9 (Heart failure, unspecified);
• M1023b: G20 (Parkinson’s disease);
• M1023c: F02.81 (Dementia in other diseases classified elsewhere with behavioral disturbance); and
• M1023d: Z91.83 (Wandering in diseases classified elsewhere).

While the codes may change, the basic logic of coding for this patient remains the same in ICD-10 as it was in ICD-9.