Home Health Coding and OASIS Expert

Question: Our new patient was admitted to home health following explantation of his infected left hip prosthesis. He’s on IV Vancomycin to treat the infection. We have orders for skilled nursing to administer the IV antibiotics for three weeks, perform lab draws for peak and trough levels, and provide wound care. How should we code for this patient? And how will our coding differ under ICD-10?

Massachusetts Subscriber

Answer: List the following ICD-9 codes for this patient:

• M1020a: 996.66 (Infection due to internal joint prosthesis);
• M1022b: V88.21 (Acquired absence of hip joint);
• M1022c: V58.81 (Fitting and adjustment of vascular catheter);
• M1022d: V58.83 (Encounter for therapeutic drug monitoring); and
• M1022e: V58.62 (Long-term [current] use of antibiotics).

The focus of care for this patient is care following the explantation of his infected left hip prosthesis. The patient is still receiving IV antibiotics to treat the infection, so rather than listing an aftercare code, you’ll report 966.66 as the first-listed diagnosis.

You’ll find a “use additional code note” at the entry for 966.66 in the Tabular List reminding you to list a V code to describe the infected prosthetic joint. Although many V codes are off limits when reporting a complication, it’s appropriate to include this status code to further specify your patient’s condition. While the note indicates that you should report a V43.6x (Joint replacement status) code for the patient, in this case, V88.21 (Acquired absence of hip joint) is the appropriate code to report because the joint is absent.

Next, list V58.81 to indicate that you will be caring for the vascular catheter. Follow this with V58.83 to indicate that you will be monitoring the patient’s use of antibiotics (the peak and trough).

In ICD-10, you would report the following codes, says Sharon Molinari, RN, HCS-D, COS-C, a home health consultant based in Henderson, Nev.:

• M1021a: T84.52xD (Infection and inflammatory reaction due to internal left hip prosthesis; subsequent encounter);
• M1023b: Z89.622 (Acquired absence of left hip joint);
• M1023c: Z45.2 (Encounter for adjustment and management of vascular access device);
• M1023d: Z51.81 (Encounter for therapeutic drug level monitoring); and
• M1023e: Z79.2 (Long term [current] use of antibiotics).

The codes you’ll report for this patient in ICD-10 are similar to those you would report in ICD-9. But the ICD-10 codes provide the detail that it’s the patient’s left hip joint that was affected.

Take note: Your ICD-10 coding manual includes a “Code also” note at Z51.81 and Z79.2 reminding you that you may want to list both codes to fully describe your patient’s condition, Molinari points out. This note doesn’t provide any sequencing instruction, however, so it’s up to your best judgment to determine which code to list first.