Responses to 11/10 scenarios; new scenarios for 11/17/14

Responses Scenarios for 11/10/14

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

Answer: There are two codes for rejection or failure of a skin graft.  Code 996.52 is used for a rejection of a natural skin graft and 995.55 is used for dislodgment, displacement, failure, 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: 707.03, 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.

T63.331D, Toxic effect of venom of brown recluse spider, accidental (unintentional) subsequent encounter.  While most insect bites are superficial injuries, a venomous spider or snake bite is coded to toxic effect of venom.  A bite by a non-venomous spider is coded to “injury superficial by site.” This wound it further complicated with cellulitis around the bite, which requires a code for the cellulitis and a code for the MRSA infection that still exists.

L03.317, Cellulitis of buttock

B95.62, MRSA

Z45.2, Encounter for adjustment and management of vascular catheter. Several Z codes are also needed to further describe the home health care to be rendered.

Z51.81, Encounter for therapeutic drug level monitoring

Z79.2, Long-term (current) use of antibiotics

New scenarios for 11/17/14

OASIS C1/ICD9:

What does the home health resource group, or HHRG, measure?

ICD-10

Patient is admitted to home health for aftercare of a CABG after an MI six weeks ago.  Patient has diagnoses of CAD, hypertension and CHF. He smoked cigarettes for 20 years but quit five years ago. Patient has been started on Coumadin and PT/INRs will be performed by nurse.

ICD-9

My patient’s surgical wound appears to be infected. There is purulence and slough at the incision site that has dehisced. The patient is receiving IV antibiotics. M1342 (status of surgical wound) is response 3 (Nonhealing). We will be providing wound care. How should I code this case?

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