Responses to 11/3; New Scenario for 11/10/14

Correct responses from 11/3/14

ICD 9:

Is it true that I should always code a wound with a wound vac as complicated? What would you do?

Answer:  While initial use and majority of current wound vac use is related to complicated wounds, that is not an absolute. A wound vac is a treatment approach used to help heal a wound. It is a costly approach, which is why wound vacs are used most often with wounds that are complex or resistant to healing. However, increasingly physicians are choosing to use wound vacs for routine wounds that aren’t complicated. For example, a surgeon caring for a very obese patient who required abdominal surgery may elect to leave the wound open to allow it to heal by secondary intention rather than close the wound with sutures and retention sutures.  The physician orders a wound vac from the beginning to accelerate wound healing process and prevent complications such as wound dehiscence that result from the strain on the suture line from excess muscle and fat in the abdominal wall. In these situations, the wound is not infected or otherwise complicated and the usual aftercare code can be used.

ICD 10:

An 86-year-old patient is admitted with a diagnosis of primary OA in his knees that the physician said is aggravated from his morbid obesity. His BMI is listed as 47. Other diagnoses that will require intervention include insulin-dependent diabetes with polyneuropathy, congestive heart failure due to hypertension and CAD. The focus of home health is to manage his arthritis pain.

M17.0, Bilateral primary OA of knee (ICD-10 doesn’t differentiate between localized and generalized. They are combination codes that include site, laterality, and whether it’s primary, secondary or post-traumatic. Pain is inherent so not additional code is required.

E11.42, Type 2 DM with polyneuropathy

I11.0, Hypertensive heart disease with heart failure

I50.9, Congestive Heart Failure

I25.10, Atherosclerotic heart disease of native coronary artery without angina pectoris

E66.01, Morbid obesity (severe) due to excess calories (instruction note to include BMI, if known.)

Z68.42, BMI 45.0-49.9

Z79.4, Long-term (current) use of Insulin.

NEW Scenario for 11/10/14

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


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.

Until next time,


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