So many of you participated this week and did REALLY well. Congratulations on your coding skills. Let’s keep it up!!
Answers for CODING SCENARIOS 9/4/14:
ICD 9 SCENARIO
Patient is post lung transplant and is being admitted to home care for management of cancer of his transplanted lung and pain management. (MAKE SURE YOU READ CODING TIPS WHEN CODING THIS CASE!)
M1020a: 996.84 Complications of transplanted lung
M1022b: 199.2 Malignant neoplasm in a transplanted organ
M1022c: 162.9 Lung Cancer
M1022d: 338.3 Neoplasm related pain management.
199.2 deals specifically with cancer in transplanted organs. It takes three codes to fully code this situation. One code indicates the complication; one indicates it’s a malignant neoplasm associated with the transplanted organ and one indicates cancer. Both cancer codes are case-mix, but points can only be gained for one. Remember that pain is only coded when it is out of the ordinary.
68-year-old female is admitted to home health post mastectomy due to breast cancer of the lower outer quadrant of her left breast. She will begin chemotherapy once the incision is healed. Medical records state she is estrogen receptor positive. She quit smoking two years ago and has COPD. Focus of skilled nursing care is incisional care and instruction related to the breast cancer.
Primary: Z48.3 Aftercare following surgery for neoplasm
Secondary: C50.512 Malignant neoplasm of lower-outer quadrant of left female breast
Secondary: J44.9 COPD; unspecified
Secondary: Z87.891 Personal history of nicotine dependence
Secondary: Z48.01 Encounter for change or removal of surgical wound dressings
Secondary: Z17.0 Estrogen Receptor Positive Status (ER+)
Other: Z90.12 Acquired absence of left breast and nipple
This is routine wound care and the malignancy remains under treatment so it is still present. Following the coding rules, all the Z codes need to be assigned. The co-morbid conditions, COPD and history of smoking, should also be coded.
NEW SCENARIOS for 9/10/14
Patient requires home care for PT due to chronic pain due to gouty arthritis and RA. Gait training, endurance, pain management and safety evaluation are ordered. Patient also has DM and history of breast Cancer.
Patient has post-operatie, acute blood loss anemia following coronary artery bypass x3 for CAD. She is taking Ferrous Sulfate and skilled nursing will monitor CBC weekly and perform wound care. She has HTN and CHF; both are stable.
Good luck and I look forward to your coding responses!