Correct Responses for 12/22/14 (HAPPY HOLIDAYS FROM QIRT)

Correct Responses for 12/22


58-year-old female patient is admitted to home care following modified radical mastectomy for adenocarcinoma of the lower-outer quadrant of the right breast. Nursing services were ordered and provided for wound healing and dressing changes. Patient will be receiving chemotherapy in the following weeks.

Answer with Rationale:

Z48.3, Aftercare, following surgery (for) (on), neoplasm (The note under this code instructs to use additional code to specify neoplasm).

C50.511, Refer to Neoplasm table, by site (breast), malignant, primary site, lower-outer quadrant. Review Tabular list for complete code assignment.

Z48.01: Admission (for), change of, surgical dressing

Z90.11, Absence (of) (organ or part) (complete or partial), breast(s) and nipple(s)) (acquired).  The fifth character ‘1’ is determined only from the Tabular List


Last week we learned about M1033, this week let’s mark the correct response based on last week’s post.

A patient is referred to home health for medication management related to his uncontrolled diabetes. The patient also has a history of hypertension. He is also on four medications for his diabetes and hypertension and also takes and aspirin a day. The patient’s wife reports that he has ‘slipped’ and fallen in the home twice in the past month but that the falls were ‘no big deal.” How should the clinician answer M1033 (Risk for Hospitalization)? MARK ALL THAT APPLY

1 – History of falls (2 or more falls – or any fall with an injury – in the past 12 months.

2 – Unintentional weight loss of a total of 10 pounds or more in the past 12 months

3 – Multiple hospitalizations (2 or more) in the past 6 months

4 – Multiple emergency department visits (2 or more) in the past 6 months

5 – Decline in mental, emotional, or behavioral status in the past 3 months

6 – Reported or observed history or difficulty complying with any medical instructions (for example, medications, diet, exercise) in the past 3 months

7 – Currently taking 5 or more medications

8 – Currently reports exhaustion

9 – Other risk(s) not listed in 1-8

10 – None of the above

CORRECT Responses: 1 – History of Falls includes both witnessed and non-witnessed falls. Response 7 – Medications, includes both prescription and over the counter medications.

Remember: This OASIS item MAY impact risk adjustment of outcome scores!!


Question: How do we know which respiratory codes to use and when?

Answer: Respiratory coding means learning about respiratory illness, how they interact and what exacerbation means.  First, you must remember that COPD is an umbrella term. Let’s take a look at the specific sections and the MD information needed to use each.

496: COPD NEC is an unspecified code that should not be used in home health when a more definitive diagnosis is available.  (CHRONIC: Nonspecific lung disease; Obstructive lung disease; Obstructive pulmonary disease (COPD) Nos.

491.21: Obstructive Chronic Bronchitis / COPD without exacerbation.

Bronchitis: emphysematous; obstructive; chronic or diffuse

Bronchitis with:  Chronic airway obstruction; emphysema (without exacerbation)

It is INCORRECT to code 491.20 for COPD without exacerbation UNLESS the term “Chronic Bronchitis” or “emphysematous bronchitis” is documented.

491.21: Obstructive chronic bronchitis / COPD with (ACUTE) exacerbation

COPD: With acute exacerbation; decompensated; decompensated with exacerbation

Emphysema: with bronchitis chronic; with (acute) exacerbation

491.22: Obstructive Chronic Bronchitis/COPD

WITH Acute Bronchitis

This is a combination code so when acute bronchitis is documented with COPD, you will only use 491.22.

Acute Bronchitis (with emphysema)

492.8: Emphysema / COPD: With emphysema NOS or Obstructive

493.2x: Chronic Obstructive Asthma

Asthma (Asthma with COPD or Chronic Asthmatic Bronchitis).

DO NOT assume that an infection such as pneumonia has exacerbated a patient’s COPD. You will code both, the pneumonia and the COPD.

We, at QIRT, wish you a very Happy Holiday Season.  We will begin with new scenarios in January 2015.

Most Sincerely,


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