Home Health Coding and OASIS Expert
Take a Closer Look at Amputation Aftercare Coding
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Question: I have a question regarding a scenario that ran in the May 2014 issue of Home Health ICD-9/ICD-10 Alert. In the scenario an agency is providing nursing and physical therapy following a below-knee amputation of the patient’s right leg due to gangrene. The patient is receiving gait training as well as aftercare. You suggested reporting aftercare code V58.49 (Other specified aftercare following surgery).
Wouldn’t V54.89 (Other orthopedic aftercare) be a more appropriate aftercare code? Or, even V58.78 (Aftercare following surgery of the musculoskeletal system, NEC)? The ICD-10 code you used is Z47.81 (Encounter for orthopedic aftercare following surgical amputation). Can you please verify the correct code and the rationale?
California Subscriber
Answer: In the scenario you mention, V58.49 is an appropriate aftercare code for this patient because the reason for the surgery was gangrene, which doesn’t have a corresponding aftercare following surgery by body system code in ICD-9. The AHA Coding Clinic for ICD-9 has suggested V58.49 and V58.73 (Aftercare following surgery of the circulatory system, NEC) in answer to questions about coding for amputations due to gangrene. You could also choose to report V58.49 for this patient, as you suggested as the alphabetical index indicates that is the aftercare code for amputations. But V58.78 isn’t appropriate for this patient. V58.78 would only be appropriate for amputations in which the cause for the amputation is coded with a code within the 710-739 (Diseases of the Musculoskeletal System and Connective Tissue) range of codes.
In ICD-10, Z47.81 is the correct code for all non-traumatic amputations. The “surgery to systems” Z codes are NEC/other specified codes, so Z47.81 would be the most specific code in this situation.
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