Answers to Coding Scenario 10/6/14
Patient with new diagnosis of atrial fibrillation, cystostomy infected with gram negative bacteria, cellulitis, uncontrolled Type II diabetes and diabetic polyneuropathy is referred to home health for observation and assessment, teaching related to new order to start Coumadin, wound care and monitoring Pro-times in addition to evaluating the status of the diabetic polyneuropathy.
596.81 – infection of cystostomy
682.2; cellulitis of abdomen (Case-mix in the Skin 2 Category)
041.85, Gram-negative bacteria
250.62, DM with neurological complication, stated as uncontrolled (Case mix in diabetes category)
357.2, polyneuropathy in diabetes
427.31 – Atrial Fibrillation
V58.83, Therapeutic drug monitoring
V58.61, Long-term (current) anticoagulants
Patient referred to home care s/p acute CVA and requires SN, PT, OT, ST due to residuals of right-sided hemiplegia, dysarthria and stuttering. Nursing is ordered for teaching disease process and new/changed medications. Patient also has hypertension and uncontrolled diabetes mellitus, and requires sliding scale insulin. The focus of care is hemiplegia.
I69.351 – Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side (dominance is not identified; ICD-10 coding guidelines state when dominance not specified but side is, you are to assume right side is dominant and left side is non-dominant).
i69.322 – dysarthria following cerebral infarction
i69.323 – fluency disorder following cerebral infarction
E11.65 – Type II DM with hyperglycemia (there is no character to indicate uncontrolled, alpha index instructs to ‘code diabetes, by type, with hyperglycemia’ if documented as uncontrolled.
I10 – Essential hypertension
Z79.4 – Long-Term (current) insulin use.
New Scenarios for October 13, 2014:
Patient referred to home health nursing for daily insulin injections due to patient’s low vision in both eyes. Home care also to do wound care 3 days a week for two small wounds of the abdomen that have recently cultured positive for staph and been derided. The physician will only classify the abdominal wounds as complicated open wounds, but they were not caused by any type of trauma. The patient is obese with Type 2 diabetes, angina, and macular degeneration. The patient is 5 feet 1 inches tall and weighs 252 pounds.
Patient is admitted for exacerbation of her Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF). She has ESRD but refuses to go to dialysis as ordered. She also has hypertension and requires oxygen.
Nearly every person who responded to the scenario last week got all codes 100% correct; GREAT JOB!!