Scenario Answers for 9/29/14
Patient with paranoid schizophrenia is admitted to home health. The skilled nurse will be providing Haldol injections BID as a new treatment for the schizophrenia, until the caregiver is proficient in administering the drug. Patient also has CHF, HTN, and Type II DM.
295.30, Schizophrenia, paranoid type, unspecified (Focus is to administer Haldol)
250.00, DM, Type II
CHF, DM, and HTN could impact the POC so they need to be added. No specific indication of how long patient to be receiving Haldol injections so wouldn’t need long-term medication code.
A 68-year-old woman with multiple sclerosis is referred to home health or PT, SN, OT following a number of recent falls related to progression of the disease. She has additional related diagnoses of neurogenic bowel and bladder, and requires intermittent catheterization, but is not incontinent. Nursing is needed to assess the patient’s competency and teach safe self-catheterization techniques, as the patient has had several recent UTIs. She also has a diagnosis of hypertension.
G35, Multiple Sclerosis
N31.9, Neurogenic Bladder
K59.2, Neurogenic Bowel, NEC
I10, Benigh essential HTN
Z46.6, Fitting and adjustment of urinary device
Z87.440, Personal history of UTI
Z91.81, History of Falls
R29.6, Repeated falls
MS is the focus of care, which is noted as cause of falls. Patient’s gait issues have progressed and resulted in falls, which are an integral component of the MS and are not coded separately.
Falls are reported in the scenario AND both codes, History of falls and Repeated falls, are used. IN ICD-10-CM, the two codes provide different information regarding the patient’s pattern of falls are not excluded from use in the same sequence of codes. History of falls indicates patin has relevant history of falls that will impact plan of care. Repeated falls is used to indicate the need for home health to investigate and treat the repeated falls. There is an Excludes 2 note in the ICD-10-CM manual providing information to the coder that the two codes may be coded together as they each exclude the other. Guidelines state “This code is assigned for encounters when a patient has recently fallen and the reason for the fall is being investigated. Code Z9181, history of falling, is for use when a patient has fallen in the past and is at risk for future codes. When appropriate, code both R29.6 and Z91.81.” (Section 1.C.18.d)
New Scenarios for 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.
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.
Until next time,