Correct scenario responses for 10/13/14
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.
707.8, Chronic Ulcer, other specified site (The most acute condition is the wound care of infection abdominal wounds and since the wounds weren’t caused by trauma and no other definitive cause is stated, the most appropriate code is chronic ulcer)
041.10, staph infection, unspecified
250.00, DM type II (Even though the nurse will be visiting every day to administer the insulin, the injected wounds are more acute than the diabetes, that is not stated as uncontrolled or noted to have any associated conditions).
362.50, Macular degeneration
369.20, Low vision both eyes (when low vision is present, code the underlying reason first.
V85.42, BMI 45.0-49.9 (clinicians may assign BMI codes based on height/weight, but only a physician can assign the diagnosis such as obesity or morbid obesity. In this case the physician didn’t provide that diagnosis so BMI value is shown to provide more information).
V58.67, Long-term use of insulin
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.
J44.1, COPD with acute exacerbation
I50.9, Heart failure, unspecified
I12.0, Hypertensive CKD with Stage 5 CKD or ESRD (HTN and CKD have an assumed cause-effect relationship in ICD-10)
N18.6, ESRD (the “use additional code” note present under I12.0)
N91.15, Patient’s non-compliance with dialysis status
N99.81, Dependence on oxygen
NEW Scenarios for 10/20/14
Instead of a scenario, this week I’ll ask you a question and give the official response next week! How do we know if osteoarthritis is localized or generalized if the documentation doesn’t say? This can affect coding, especially after joint replacement surgery.
Patient had a bowel obstruction that was treated with a bowel resection of the descending colon and placement of a colostomy. Nine months after surgery, she developed an enterocutaneous fistula from the ileum to the abdominal wall that is still present. The most recent hospitalization was for nausea and vomiting, which is currently controlled, and the insertion of a PICC line for TPN due to malabsorption syndrome resulting from her inability to absorb food from the GI tract. Patient also has Type 2 diabetes. Orders for home health is care of fistula, colostomy and PICC line, and monitor TPN and diabetes. Nursing will provide teaching and training to caregiver for colostomy care since patient refuses to provide any self-care for the colostomy.
Are there specific ICD-10 scenarios you would like to see? I look forward to your responses!