You Be the Coder: WHICH CODE IS PRIMARY FOR HIP REPLACEMENT?- Published on Mon, Oct 17, 2005
Question: You admit a patient from the hospital after a total right hip replacement following osteonecrosis. The physician plans for PT in an outpatient setting when the patient has recovered sufficiently. Nursing will care for the surgical wound. How would you code this?
Answer: Keith Nielsen, RN, HCS-D, PPS/OASIS Coordinator with Great Lakes Home Healthcare in Erie, PA, suggests coding this scenario as follows.
Assuming the need for nursing is for normal, post-operative wound care rather than some sort of wound complication, code:
• M0230a: V54.81 (Aftercare following joint replacement)
• M0240b: V43.64 (Organ or tissue replaced by other means, joint, hip)
• M0240c: V57.1 (Other physical therapy)
• M0240d: 781.2 (Abnormality of gait)
• M0240e: V58.3 (Attention to surgical dressings and sutures)
• M0245a: 781.2 (Abnormality of gait).
Because the need for both physical therapy and nursing services is a result of the surgery, the aftercare for joint replacement code would be primary.
Don’t make your coding decision by counting the number of visits; both PT and nursing are providing aftercare of the joint replacement so it should be coded first, experts advise. Next, indicate the joint location, then abnormality of gait and the other V codes. Code 781.2 is placed in M0245 for case mix calculation.
Depending on the hospital dates, OASIS responses M0190 and M0210 would probably be 733.42 (Aseptic necrosis of bone, head and neck of femur). You would not code this in M0230/M0240 because the necrosis would have been removed and would no longer exist following the surgery.