SCENARIO ANSWERS for 9/10/2014
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.
M1020a: V57.1 Encounter for other PT
M1022b: 274.00 Gouty Arthritis
M1022c: 714.0 RA
M1022d: 338.29: Other chronic pain
M1022e: 250.00: DM
M1022f: V10.3: History of Breast Cancer
There is no indication that nursing will be involved so you will use the V57.1, note it can ONLY be used primary. The underlying reason for therapy is gouty arthropathy. It is an active disease and should be coded in M1022 just below PT. RA is the next disease. Although the tabular indicates to use an additional code to identify manifestations at 714.0, no manifestations are indicated in this scenario so additional codes are not needed. They type and control status of the DM is not specified, so it is appropriate to code 250.00; unspecified not state as uncontrolled. Chronic pain is specifically noted in the scenario description and will be addressed through pain management activities. Acute pain codes are the default codes in 338.x; unless documentation specifies chronic pain, as in this situation.
Patient has post-operative, 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.
Primary: Z48.812: Encounter for surgical aftercare following surgery on circulatory system
Secondary: Acute posthemorrhagic anemia
Secondary: I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
Secondary I50.0 CHF
Secondary: Z48.01: Encounter for surgical wound dressings
Other: Z95.1; Presence of aortocoronary bypass graft
Focus of care is the wound care. Due to lab draws and iron supplement dosing, anemia is the next area of focus. HTN and CHF are co-morbid conditions that should always be included when present.
NEW SCENARIOS for 9/22/2014
An 86-year-old patient is admitted for monitoring and observation related to an episode of secondary thrombocytopenia (still resolving), which was due to an adverse reaction to ciprofloxacin used to treat a UTI. The UTI has been resolved. The patient is confined to a wheelchair due to hemiplegia on his dominant side as a late effect of CVA two years ago. He has recently established a Living Will that specifies he does not want to be resuscitated if he should experience a cardiac arrest and the physician has added a DNR order to the Plan of Care.
Patient has Type I diabetes with both retinopathy and End Stage Renal Disease. He attends dialysis three times per week. He also has HTN and has just been discharged from the hospital for an exacerbation of acute on chronic diastolic and systolic heart failure. Skilled nursing is ordered to monitor the CHF, medication compliance, obtaining weights, assessing lung sounds and edema, and teaching.
I look forward to your responses!
Kimberly … email to firstname.lastname@example.org