Responses to 10/20 Scenarios and New Scenarios for 10/27/14

Correct Responses to 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.

ANSWER:  If documentation doesn’t indicate this, you will to determine from the physician if the OA is localized (in one spot) or generalized (affects multiple joints).  You should also determine if the OA is primary (caused by aging) or secondary (caused by trauma or other conditions).

The operative report for a patient who has undergone joint replacement will usually specify that the surgery was done to treat OA in a specific joint.

IMPORTANT note for coding: Bilateral OA of the same site is considered localized.

ICD 10:

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.

K63.2, Fistula of Intestine

K90.9, Intestinal malabsorption, unspecified

Z43.3, Encounter for attention to colostomy

E11.9, DM 2 without complications

Z45.2, Encounter for adjustment and management of vascular access device.

Z79.899, Other long-term (current) drug therapy

ICD 9:

How do we know what integral symptoms are to a disease?  We aren’t supposed to code them with diseases like heart failure, but is there a list of them somewhere? Do you know the answer??  I’ll post the official answer next week!

ICD 10:

Patient is referred to home care s/p muscle flap to treat a stage 4 pressure ulcer of the coccyx.  Patient also has a stage 2 pressure ulcer to left hip and on right buttock, and a stage 1 on the right hip and left buttock.  Wound care is ordered.

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