Responses to 11/10; New Scenario for 11/17/14

Responses to Scenario for 11/10/14

Question:  How do I code a patient who had a failed skin graft?

Answer: There are two codes for rejection of a failure of a skin graft. Code 996.52 is used for the rejection of a natural skin graft and 996.55 is used for a dislodgment, displacement, failure, non-adherence, poor incorporation or shearing of an artificial skin graft and decellularized allodermis.

Example: Patient with a natural skin graft to a stage III pressure ulcer of the buttock has failed.

M1020: 996.52, skin graft failure or rejection

M1022: 707.05, pressure ulcer of buttock

M1022: 707.23, pressure ulcer stage III

ICD-10

Patient admitted with urinary tract infection. Patient has had a foley catheter for the last several weeks due to urinary retention. The culture revealed organism to be staphylococcus aureus that is resistant to penicillin.

N39.0, UTI, site not specified, Instruction in tabular list to use addition code to identify infection agent.

B95.62, MRSA infection as the cause of disease classified elsewhere. Don’t confuse the A49 category with the B95 category. Both indicate Staphylococcus aureus infection, but the A49 category denotes an unspecified site while the B95 category denotes the organism as the cause of diseases classified elsewhere.

R33.9, Retention of urine, unspecified

Z46.6, Encounter for fitting and adjustment of urinary device. The reason for the urinary device should be coded and the Z code for Foley should be listed as an additional diagnosis.

New Scenarios for 11/17/14.

Question: What catheter or implant sites are considered surgical wounds in OASIS?

ICD-10:

Patient was bitten by a brown recluse spider on the buttock and required an I&D due to an abscess.  Open area is 5.0 cm long, 2.0 cm wide and 4.0 cm deep.  Wound is still infected with MRSA and cellulitis surrounding the wound. Patient is referred to home health for wound care, IV antibiotics and p eat and trough to be performed by nurse.

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