Scenarios for 12/8/14
This 88-year-old gentleman is receiving home care for his coronary artery disease and the cardiac pacemaker placed during his hospitalization last week. He continues to gain strength but requires wound checks, dressing changes, and medication management ongoing. Assign the correct diagnosis codes.
Z48.812, Encounter for surgical aftercare following surgery on the circulatory system
I25.10, Atherosclerotic heart disease of native coronary artery without angina pectoris
Z48.01, Encounter for change or removal of surgical wound dressing
Z95.0, Presence of cardiac pacemaker
Question: What is included in an aftercare code such as aftercare of surgery? Monitoring incisions? Wound care? If so, why do we also use the wound care V58.3x series of codes for non-complicated wounds?
Answer: Here is the response from the Official Coding Guidelines: ” Aftercare visit codes cover situations when the initial treatment of a disease or injury has been performed and the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease. The aftercare V code should not be used if treatment is directed at a current, acute disease or injury. The diagnosis code is to be used in these cases… Aftercare comes should be used in conjunction with any other aftercare codes or other diagnosis codes to provide better detail on the specifics of an aftercare encounter visit, unless otherwise directed by the classification. The sequencing of multiple aftercare codes is discretionary. Certain after V code categories need a secondary diagnosis code to describe the resolving condition or sequelae; for others, the condition is inherent in the code title. Additional V code aftercare category terms include fitting and adjustment, and attention to artificial openings.”
The word “aftercare” includes a comprehensive approach to patient and patient’s needs in a specific type of encounter. Surgical aftercare could include monitoring and observing the wound, or teaching about activity levels, nutrition, etc. Aftercare does not always include dressing changes (V58.31), so this code should be added if change or removal of dressings is part of your care. Surgical aftercare codes can be used whenever you are providing aftercare due to surgery, NO matter how many disciplines are involved in care.
New Scenarios for 12/15/14
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.
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
Question: How do we know which respiratory codes to use and when?