Coding: Aftercare for Fractures

Table 25 should ALWAYS  be referenced when coding fractures and aftercare in the home health setting The incorrect pairing of a fracture code with an aftercare code can cause reimbursement loss for your agency. Click here to view the table: Table 25 Fx and V codes

ICD-10 Fracture Coding Tidbit:

Coding aftercare for fractures in ICD-10 will not require the use of a  V code for aftercare. The fracture code is made up of 7 characters, with the 7th character notating the episode of care.

The 7th character options for each fracture code include the following:

A: Initial encounter for closed fracture

B: Initial encounter for open fracture

D: Subsequent encounter for fracture with routine healing

G:  Subsequent encounter for fracture with delayed healing

K: Subsequent encounter for fracture with nonunion

P: Subsequent encounter for fracture with malunion

S: Sequela

*Notice that the fracture codes will include laterality, open/closed, healing/nonhealing, nonunion/malunion, sequela (late effects)*

Example: Patient admitted into home health for aftercare of a right foot fracture.

M1010: S92.901A

M1016: S92.901A

M1022:  S92.901D


Aftercare Coding for Heart Valve Replacements

Like many coders, when coding aftercare for a valve replacement your first instinct may be to automatically assign V58.73 aftercare following surgery of the circulatory system because the heart valve is part of the circulatory system– this is incorrect.

The key to assigning the correct aftercare code for a heart valve replacement is to determine  whether a  mechanical or tissue heart valve was used to replace the diseased or damaged valve.

A mechanical heart valve is a prosthetic valve that replicates the natural heart valve. Types of mechanical valves include: caged-ball, tilting-disk, and bileaflet.

A tissue (bioprosthetic) heart valve is transplanted from another heart, whether it be a human or animal.  Types of tissue valves include: allograt/isograft and xenograft (pig valve). Sometimes, a tissue valve may be referred to as bioprosthetic.

When a mechanical heart valve is utilized as a replacement, the correct aftercare code is V58.73 aftercare following surgery of the circulatory system and  include V43.3  heart valve replaced by other means-prosthetic.

On the other hand, when a tissue valve is used to replace a heart valve, the correct aftercare code is V58.44 aftercare following organ transplant with V42.2 heart valve replaced by transplant.

Refer to the patients operative report for the type of valve used.

Malignant HTN

There seems to be much confusion regarding the coding of malignant hypertension in home care. Malignant hypertension (401.0)  is a specific type of hypertension, it is NOT considered an exacerbation of  benign hypertension (401.1). If the MD specifically documents malignant hypertension as the type of hypertension, you must code it as such. It is not appropriate to code the HTN as unspecified when the MD specifies the type.

Also, do not assume a patient has benign hypertension when malignant is not documented. If the specific type of hypertension is not documented, the coder should assign code 401.9, Unspecified Essential Hypertension.

**Hypertensive crisis nor uncontrolled hypertension does not mean the patient has malignant HTN, these are merely non-essential modifiers. Read your documentation carefully and thoroughly before assigning a code for hypertension.

Interested in learning more about coding diseases of the Cardiovascular System, click here for a free CEU!


Coding Urinary Tract Infections (UTI)

Urinary tract infections affect millions of people, it is one of the most common types of infections today. A UTI is a bacterial infection of any part of the urinary tract. It is important to know that the urinary tract is made up of the kidneys, ureters, bladder, and urethra.

Factors such as, pregnancy, diabetes, urinary obstructions, foreign bodies, presence of a urinary catheter, and congenital abnormalities can put a person at a higher risk for developing a UTI.

When coding a UTI it is important to know what part of the urinary tract is affected by the UTI.  The location will determine what code you will assign. If the infection is affecting the:

Bladder (cystitis)- see Category 595

Kidney (pyelonephritis)- see Category 590

Unknown site (UTI NOS)- 599.0

Always remember to add a code for the organism causing the infection, if known.

UTI due to Urinary Catheter

If the cause of the UTI is due to a urinary catheter, assign code 996.64 followed by the appropriate UTI code.

Post-operative UTI

If the physician states the patients postoperative UTI is linked to a procedure, two codes are required; 997.5, Complications affecting specified body systems, urinary complications, and the appropriate UTI code. If the causative organism is identified it is also coded.

ICD 10 codes:

Personal History of UTI:  Z87.440

Urinary Tract Infection unspecified: N39.0

Alzheimer’s Coding

Let’s review some Alzheimer’s coding on this Alzheimer’s Action Day!

When coding Alzheimer’s, always remember to review documentation to determine if the patient has an additional diagnosis of Dementia. If a patient has both Dementia and Alzheimer’s, you will assign two codes: 331.0 Alzheimer’s and a code from Category 294.1x.

The fifth digit on 294.1x indicates whether or not the patient has behavioral disturbances. If the patient is exhibiting  aggressive, combative, or violent behaviors assign code 294.11. If the patient is wandering off, you should also add code V40.31 wandering in conditions classified elsewhere.

Use caution when coding Alzheimer’s as the primary diagnosis in home care. Widespread medical edits are being selected on claims with an Alzheimer’s/Dementia diagnosis as primary beyond 60 days. It is not medically necessary to continue repeated teaching to a patient with this disease. If teaching is directed to a new caregiver than that will suffice.

Understanding M1016

Item M1016 identifies any change that has occurred to the patient’s treatment regimen or medications within 14 days prior to assessment.  M1016 is used to identify new diagnoses or diagnoses that have exacerbated and is used to help the clinician develop an appropriate plan of care, since patients who have recent changes in treatment plans have a higher risk of complications.

N/A should be marked if changes in treatment regimen are do to the patients conditions improving.

Important points to remember about M1016:
  • No surgical codes.
  • Avoid symptoms codes when possible.
  • No V-codes or E-codes.
  • M1016 may include the same diagnosis as M1010 if the condition was treated during an in-patient stay and caused changes in the treatment regimen.

Understanding M1010

As a coder, understanding the purpose of M1010 may not be so clear. Many times clinicians enter diagnosis(es) into M1010 that are not appropriate.

M1010 allows for a more comprehensive picture of the patient’s condition prior to the start or resumption of home care.  The key to understanding M1010 is knowing that the diagnosis(es) entered in this item include only diagnosis(es) that were “actively treated” in the inpatient setting within the 14 days preceding the date of the assessment M0090.   “Actively treated” should be defined as receiving something more than the regularly scheduled medications and treatments necessary to maintain or treat an existing condition.

Things to remember:

  • Avoid the use of symptom codes if possible.
  • No V or E codes should be listed in M1010.
  • Only conditions receiving something more than the regularly scheduled medications and interventions should be listed in M1010.


Lower Extremity Weakness

Many times, lower extremity weakness is documented on the patient’s assessment. Should lower extremity weakness be coded as muscle weakness? Absolutely not.

Lower extremity weakness, without mention of muscle weakness should be assigned code 729.89, other musculoskeletal symptoms referable to limbs.

If your patient is receiving physical therapy, always remember to check the manual muscle test (MMT) scores documented by the therapist on the assessment. If the scores are low, then you can question whether or not it’s actually muscle weakness affecting the lower extremities.


R29.898 Other symptoms and signs involving the musculoskeletal system

M62.81 Muscle Weakness

Cataract Coding

A cataract is a clouding that develops in the crystalline lens of the eye that obstructs the passage of light.  There are various types of cataracts: nuclear, cortical, mature, and hypermature. Cataracts can be a secondary effect of disease such as DM, HTN, or advanced age. Cataracts can cause blindness if left untreated.

Cataracts are classified in Category 366 by their type:

366.0x Infantile, juvenile, and presenile cataracts

366.1x Senile cataracts (most common type of cataract in diabetics, but NOT considered a diabetic cataract)

366.2x Traumatic cataracts

366.3x Cataract secondary to ocular disorders

366.4x Cataract associated with other diseases

366.5x After-cataract

366.8 Other cataract

366.9 Unspecified cataract

*Remember, when coding a cataract that is documented as a diabetic manifestation, use a diabetic ophthalmic manifestation code 250.5x/249.5x followed by 366.41 diabetic cataract. 

Diabetic Cataracts are common in Type 1 diabetics and rarely seen in Type 2 patients.