Eli's Rehab Report

Question: I am seeing a Medicare patient who came in with a script for the diagnosis of s/p debridement of osteomyolitis of the right shoulder. He had right RTC tear repair surgery a year ago. Background: The patient is HIV-positive, and he contracted MRSA when he was hospitalized. Doctors treated the infection with antibiotics, and he recovered.

He recently returned to my clinic with bicipital tendonitis and tore the RTC again. We started therapy, and the MRSA returned. Doctors told him that apparently the infection lies dormant in his shoulder, and this may be a continuing problem for him. So the surgeon went back in and performed the debridement, and the patient is back on antibiotics. I am starting therapy again, so my question is, which ICD-9 code can I use since he is returning after another surgery that treated the MRSA infection?

Washington Subscriber

Answer: Based on your question, it seems you are treating the bicipital tendonitis and the shoulder injury when the patient returned to you after the last surgery. If that is the case, it is difficult to give you the exact treatment diagnoses without all of the objective data, tests, measurements, etc.

To narrow down a therapy diagnosis, ask yourself why this patient requires skilled therapy services, what his deficits are, and what you are treating.

Some treatment diagnoses that may apply to this patient are ICD-9 codes 719.41 (Pain in joint; shoulder region), 719.42 (Pain in joint; upper arm), and 718.41 (Contracture of joint; shoulder region). A medical diagnosis from the physician may be bicipital tenosynovitis (726.12).