Sample Scenario Model
| Source Title: | Diagnosis Coding Pro for Home Health |
| Publication Date: | December 2007 |
| Publisher: | DecisionHealth |
Scenario from "Diagnosis Coding Pro" for Home Health
(December 2007 issue)
This example illustrates the accurate assignment of primary and secondary codes for home health.
A patient falls and is referred to home care for care of a pelvic fracture. No surgical intervention. PT/OT is ordered for gait, strengthening, fall precautions/safety. Nursing is ordered for pain management and teaching pain meds.
This is a multiple therapy example, but the reason for admission is for aftercare of the pelvic fracture. It should be coded like this:
M0230a: V54.19, aftercare of healing traumatic fracture of other bone
M0246: 808.8, fracture of pelvis, unspecified
M0240b: 781.2, abnormality of gait
M0240c: 728.87, muscle weakness
M0240d: 338.11, acute pain due to trauma
E888.9, unspecified fall
Activity Overview and Discussion
The fracture code is allowed to be put in M0246, but is not appropriate to home health in M0230 or the M0240s. This is a reference to the Coding Guidelines’ explanation of acute care and non-acute care. Breaks are acute care treatments, not home care. Because M0246 is for payment, it can be placed there without retribution.
Gait training is the primary function, so that should be listed hi in the process. 781.2 is appropriate in this case because it is the symptom being treated. The strengthening is shown in 728.87.
"Normal" pain after surgery is not coded separately, but because nursing is being ordered for specific pain management, it is above the normal realm of post-operative pain and should be coded.
The E code is not required here, but rounds out the picture of the patient’s health and care.
Discussion
Often, people default to V57 when they see that PT is ordered, but that would not be a good use of coding, nor show a good understanding of coding and care, in this example. The aftercare is specifically mentioned as the reason for admission. Even though a V code footnote implies the V57 series can be used secondarily, I wouldn’t do that in general, and certainly not here, where it’s not an equal reason for care.
I always code E codes when I can. I think using them paints an accurate picture, and it gives the RHHI information on what has happened to the patient for statistical reasons.
