Responses to 10/27 and New Scenario for 11/3/14

Correct responses from 10/27/14

ICD 9:

Question: How do we know what integral symptoms are to a disease? We aren’t supposed to code them with diseases like heart failure, but is there a list of them somewhere? Do you know the answer?? I’ll post the official answer next week!

Answer:  There is no master list of integral symptoms for a disease.

Coding guidelines state that signs and symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.

Conversely, the Guidelines also state that additional signs and symptoms that may not be associated routinely with a disease process should be coded when present.

The best places to find accurate signs and symptom information is a medical-surgical textbook or by looking at the website of a reputable nonprofit organization that deals with the disease.  For example, the following symptoms are considered integral to heart failure, per the American Heart Association:

  • Shortness of breath or dyspnea
  • Persistent cough or wheezing
  • Build-up of excess fluids in the body, most often:
    • In the lower extremities (dependent edema)
    • In the lungs (pulmonary edema)
    • In the pleural cavity (pleural effusion)
  • Heart palpitations
  • Tiredness or fatigue

ICD 10:

Patient is referred to home care s/p muscle flap to treat a stage 4 pressure ulcer of the coccyx. Patient also has a stage 2 pressure ulcer to left hip and on right buttock, and a stage 1 on the right hip and left buttock. Wound care is ordered.

Z48.817, Encounter for surgical aftercare following surgery on the skin and subcutaneous tissue (This patient has so many pressure ulcers that it may be hard to remember the aftercare is the reason for admission).

L89.150, Pressure ulcer of sacral region, unstageable (A muscle flap is considered a surgical wound for OASIS purposes, but is coded as a pressure ulcer with a combination code that includes the location (coccyx) and stage – in this case it’s unstageable since it’s covered with a muscle flap. This code will follow the routine aftercare code).

L89.222, Pressure ulcer left hip stage 2 (Next, code the remaining pressure ulcers in order of worst ulcer to least-skilled. There are combination codes in ICD-10 that include site, laterality and stage).

L89.312, Pressure ulcer right buttock stage 2

L89.231, Pressure ulcer left buttock stage 1

L89.211, Pressure ulcer right hip stage 1

Z48.00, change or removal of non-surgical dressing

Z48.01, change or removal of surgical wound dressings

New Question and Scenario for 11/3/14

Is it true that I should always code a wound with a wound vac as complicated?  What would you do?

ICD 10:

An 86-year-old patient is admitted with a diagnosis of primary OA in his knees that the physician said is aggravated from his morbid obesity. His BMI is listed as 47. Other diagnoses that will require intervention include insulin-dependent diabetes with polyneuropathy, congestive heart failure due to hypertension and CAD.  The focus of home health is to manage his arthritis pain.

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