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Home Health Coding and OASIS Expert

Coding Quiz:
Can You Assign the Correct 7th Character in These Scenarios?

Take note of expanded options for fractures.

While “D” for subsequent encounter may be your default seventh character in home health, there will be times when you’ll need to select one of the other options. Give your coding skills a workout with these example scenarios.

Scenario 1: Your 27-year-old female patient was admitted to home health following a two-month acute care hospital stay for abdominal wound dehiscence following failed gastric bypass surgery two years ago. The patient was admitted for continued management and treatment of her internal abdominal wound dehiscence that requires packing, TPN support secondary to postsurgical malabsorption, postoperative wound infection with methicillin resistant Staphylococcus aureus, intractable chronic pain related to surgery, and generalized deconditioning. How would you code for this patient?

Scenario 2: You will be providing IV antibiotics to treat your patient’s Staphylococcus aureus infection of her right hip joint prosthesis. How would you code for this patient?

Scenario 3: Your 70-year-old patient broke her right humerus at mid shaft (comminuted) in a go-kart accident when riding with her grandson. She had an open reduction internal fixation (ORIF) and the fixation device has come loose resulting in a nonunion of the fracture. She is immobilized until further surgery to repair. How should you code for this patient?

Scenario 1 answer: List the following codes for this patient, says Judy Adams, RN, BSN, HCS-D, HCS-O, AHIMA Approved ICD-10-CM Trainer with Adams Home Care Consulting in Asheville, N.C.:

  • M1021a: Other complications of other bariatric procedure — K95.89;
  • M1023b: Disruption of external operation (surgical) wound, not elsewhere classified; initial encounter — T81.31xA;
  • M1023c: Infection due to other bariatric procedure — K95.81;
  • M1023d: Methicillin resistant Staphylococcus aureus infection as the cause of diseases classified elsewhere — B95.62;
  • M1023e: Postsurgical malabsorption, not elsewhere classified — K91.2;
  • M1023f: Other chronic postprocedural pain — G89.28; and

Other pertinent diagnosis: Muscle weakness, generalized — M62.81.

There is no specific code for dehiscence related to bariatric procedures, so you’ll use the “other complication” code which has a note to “use additional code,” if applicable, to further specify complication, Adams says.

In this situation, the additional dehiscence code explains the complication further. The dehisced wound requires active treatment, so you’ll code for it with seventh character “A,” Selman-Holman says. If the dehisced wound was healing, you might report seventh character “D.” But in this case, after two months the wound still requires packing, so “A” is the correct seventh character, she says.

The patient has current complications (postoperative dehiscence and infection) related to a previous bariatric surgery, so it’s appropriate to use the complication of bariatric surgery codes rather than the general postoperative complications, NEC codes, Adams says.

Tip: Because there is a complication present, you won’t report an aftercare following surgery code for this patient. ICD-10 doesn’t define a time limit for the development of a complication, so even years after the surgery it’s possible to code for this complication, Adams says.

Because dehiscence is assumed worse than an infection, you’ll sequence this condition prior to the infection. Also, you’ll add the pain code (G89.28) for chronic post-surgical pain, Adams says. Remember, the physician must specify chronic pain before you can code for this condition.

Scenario 2 answer: List the following codes for this patient, says Lisa Selman-Holman, JD, BSN, RN, COS-C, HCS-D, HCS-O, AHIMA Approved ICD-10-CM Trainer/Ambassador of Selman-Holman & Associates, LLC, CoDR — Coding Done Right and Code Pro University in Denton, Texas:

  • M1021a: Infection and inflammatory reaction due to internal right hip prosthesis — T84.51xA and
  • M1023b: Methicillin susceptible Staphylococcus aureus infection as the cause of diseases classified elsewhere — B95.61.

Because your patient is still receiving active care for her infected hip replacement, you’ll use seventh character “A” for initial encounter. Remember, seventh character “A” isn’t tied to the setting in which the care is provided, but to the condition for which the care is provided.

Follow this with B95.61 to indicate that your patient’s infection is caused by Staph aureus.

Scenario 3 answer: List the following codes for this patient, says Selman-Holman:

  • M1021a: Displacement of internal fixation device of right humerus — T84.120A;
  • M1023b: Displaced comminuted fracture of shaft of humerus, right arm; subsequent encounter for fracture with nonunion — S42.351K.

List the code for your patient’s complication first, Selman-Holman says. In this case, that means the displacement of the internal fixation device. Seventh character “D” is not appropriate because the situation is not healing/recovering, so you’ll list ‘A’ for this patient.

Follow this with a code to describe the condition resulting from the complication — nonunion of her fractured humerus. In this case, seventh character “K” indicates that you are providing subsequent care of a fracture with nonunion.