Wiki Joint replacement following fx

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kristenderosa@gmail.com

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I have a resident that has returned to a SNF after a L hip replacement. He was initially placed in the rehab facility for a fracture of the L acetabulum and I used S32.432D for his admission in 2021. Fast forward to today, the pain was so severe they determined he should have a hip replacement. My question in: The book states you cannot use an S code with the seventh character D AND the Z47.1 (Aftercare following joint replacement therapy) in the same encounter, but I want to capture the fact that they need to do the replacement because of the severe pain he was in. The provider never labeled his fracture as delayed healing, so I am not sure what to do with how to sequence the claim to capture both the replacement and the reason for the replacement.

Any help would be appreciated. Thank you :)
 
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This is not a situation I've come across before, and I don't have any references to support it, but my thought is that if the more conservative care did not provide for healing and a surgery is needed, then this becomes active care of the fracture again, and I would think it should be coded S32.432A. Then following the surgery during recovery, the diagnosis reverts back to S32.432D. Perhaps someone here's who's come across this scenario may have additional input.
 
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Did the patient have the hip replaced already and you are coding the post operative visit? I am a little confused by your question. If you are coding the surgery it would not be Z47.1. Or, are you talking about a post-operative visit following the THA?
 
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amyjph said:
Did the patient have the hip replaced already and you are coding the post operative visit? I am a little confused by your question. If you are coding the surgery it would not be Z47.1. Or, are you talking about a post-operative visit following the THA?
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The post op visit. He is coming back to a skilled nursing facility for rehab. I know you never use an aftercare code for a fracture that is considered routine healing. I might be overthinking the whole situation. This is the timeline of events:

October of 2021- admitted with S32.432D for routine care of his fracture. With all of his other comorbidities, they decided not to do a replacement at the time this admission.
November 2021-April 2022- remains in therapy for said fracture.
April 2022- Decided the pain was too severe (despite the risks/complications of having the hip replaced) and went ahead with the procedure. I snipped a bit of the provider note below:
1653067092425.png
May 2022- Returns from hospital to previous SNF s/p L THA. What code should I use? The aftercare code or still the fracture code with a seventh character D?

That may be a long winded explanation and I might be overthinking it, but I would love to hear your thoughts.

Thank you so much!
 
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As per the guidelines, which you cited in your original post, you should not use the aftercare code for injuries. Since the note you shared clearly indicates a fracture diagnosis, you would use S32.432D to report the post-operative care.
 
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