Coding Answers to 8/28/14 scenarios and NEW Coding scenarios for 9/3/2014

ICD-9 Scenario:

An 86-year-old male is admitted to home health after being treated in the hospital for pneumonia caused by homophiles influenza that resulted in sepsis. He is still receiving IV antibiotics for the still-resolving infection. He also has diabetes with PVD. The focus of care will be the continued treatment and monitoring of infection and sepsis.

038.41: Septicemia due to Hemophilus Influenzae (H. Influenzae)

995.91: Sepsis

250.70: Diabetes with peripheral circulatory disorders, type 2, not stated as uncontrolled

443.81: Peripheral angiopathy in diseases classified elsewhere

V58.81: Fitting and adjustment of vascular catheter

V58.61: Long-term (current use of antibiotics)

The patient’s sepsis and infection are the focus of care.  Since the underlying infection is known, it is coded as primary followed by the correct sepsis code.

038.41 is the appropriate code choice for the patient’s underlying infection.  It has septicemia in the code title, despite the fact that it isn’t entirely accurate for the condition it captures.

The patient’s diabetic PVD, which is coded as a diabetic manifestation according to the diagnostic statement, will impact his plan of care and should always be coded.

V codes indicate IV care and antibiotic use and should also be coded.

Additional note: 250.70 is a case-mix code and add points in the clinical domain as a Diabetes Diagnosis.  In the CY2015 Proposed Rule, CMS has proposed that diabetes be taken away as a case-mix diagnosis.

ICD-10 Scenario:

Patient is admitted to home health care following hospitalization for UTI with E coli. He returns home on oral antibiotics and skilled nursing will obtain U/A upon completion of the antibiotics. He also has a HTN and chronic kidney disease stage 3.

N39.0 : Urinary Tract Infection, Site not specified

B96.20 : Unspecified E.coli as the cause of diseases classified elsewhere

I12.9: Hypertensive CKD with stage I through stage IV CKD, or unspecified CKD

N18.3: CKD, Stage III (Moderate)

The UTI (N39.0) is coded as primary since it is the reason for home care.  Code B96.20 is the correct infection code as it specifies as the cause of disease.  Hypertension is a co-morbid condition, and ICD-10_CM DOES presume a causal relationship between HTN and CKD, so both conditions are coded.

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!)

ICD-10 SCENARIO

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.

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