Home Health Coding and OASIS Expert

Question: Our new patient was referred to home health with a new diagnosis of congestive heart failure (CHF). He also has a cystostomy infected with gram negative bacteria, cellulitis of the groin, uncontrolled type 2 diabetes, and diabetic polyneuropathy. How should we code for him?

Answer: Code for this patient as follows, says Judy Adams, RN, BSN, HCS-D, HCS-O, AHIMA Approved ICD-10-CM Trainer with Adams Home Care Consulting in Asheville, N.C.

• M1021a: (Heart failure, unspecified) I50.9;
• M1023b: (Cystostomy infection) N99.511;
• M1023c: (Cellulitis of groin) L03.314;
• M1023d: (Other specified bacterial agents as the cause of diseases classified elsewhere) B96.89;
• M1023e: (Type 2 diabetes mellitus with diabetic polyneuropathy) E11.42; and
• M1023f: (Type 2 diabetes mellitus with hyperglycemia) E11.65.

You’ll sequence your patient’s congestive heart failure first because it’s a new diagnosis and will require skilled nursing to provide a considerable level of teaching, Adams says. Report the CHF with I50.9.

Next, report your patient’s infected cystostomy (N99.511). You’ll notice that this code is located in Chapter 14, Diseases of the Genitourinary System. You’ll also find codes for other complications of a cystostomy, other complications of external stoma of urinary tract, and other complications of stoma of urinary tract in this chapter.

Follow your patient’s infected cystostomy with the associated cellulitis (L03.314), and the infectious organism (B96.89). ICD-10 code A49 codes should never be used for known bacterial infections, since they are for use for unspecified sites. This site is known. B96.89 is the appropriate code to report for an infection cause by gram negative bacteria.

Next, list E11.42, a single code that indicates your patient has type 2 diabetes that is causing his diabetic polyneuropathy.

Your patient’s type 2 diabetes is documented as uncontrolled, but ICD-10 doesn’t classify diabetes as controlled or uncontrolled like ICD-9 did. Instead, you’ll list a code for diabetes with hyperglycemia (E11.65).