Posts tagged ‘781.2’

September 4, 2010

Watch diagnosis codes that exclude each other

Here is another question I recently received:

Question: We are having an audit, and the surveyors indicated the primary diagnosis is not supported by the secondary diagnoses: 781.2, 781.3, 728.87, V15.88, 438.84, 386.54

That the status post head injury from 20 years ago is important to the patient’s condition and abilities. We have argued this information is included in the comments, but did not see the need to code here.

This is the admission information included: 22 y/o female referred to therapy d/t decline in function and recent falls. Hx includes head trauma since age of 2 w/weakness/hypertonicity right side of body. Has had PT & OT since 2 years old. Lives w/parents, PLOF independent w/all transfers and ambulates w/o assistive device. She presents w/generalized weakness, ataxic gait & requires SBA w/transfers for safety.

Father refuses other therapy at this time.

Lisa says: This is a late effect of head injury, which means you code the residual deficits (conditions produced) first, followed by the late effects code. It appears that the patient has hemiplegia as a result of a head injury (described as weakness/hypertonicity right side of body). In addition, abnormality of gait (781.2) and ataxia (781.3) exclude each other, so they would not be coded together, nor would they be coded with hemiplegia.

Weakness and ataxia are part of the hemiplegia and would not be coded in addition. 438 is a late effects of CVA code, and the patient doesn’t appear to have had a CVA. (It is, unfortunately, common for coders to automatically think of the 438 series when coding hemiplegia, but remember that ONLY deals hemiplegia with stroke. Go to the 342 series for other hemiplegia.)

I would code this patient with 342.1x (fifth-digit decided by whether this is affecting dominant or non-dominant side), 907.0, V15.88.

August 24, 2010

Confusion over case mix and 781.2? No.

Question: People were overusing 781.2, and then the criteria changed on how to capture case mix points: You also needed and ulcer and/or IV therapy. Is this still the criteria?

Lisa says: The criteria haven’t changed since January 2008.  Abnormality of gait is still case mix, but does not receive points unless the patient also has a pressure ulcer, it’s an early episode and there are less than 14 therapy visits. (See row 19 of CMS’s Table 4 for the official cite.)

Infusion therapy has never been part of the criteria for 781.2. Always remember that you code for medical necessity and services provided, NOT case mix.

May 19, 2010

Coding and OASIS puzzle quiz!

Sometimes we need to think through some of the tasks we do over and over … what do they mean? This OASIS and coding quiz gives you a chance to think and solve a puzzle!


May 6, 2010

A look at gait

Abnormality of gait is one of the most talked about, most misused, and abused code. In this post, I want to look at different types of gait, and which can be used with 781.2. This will show the importance of reading notes in the your manual to understand where to go to find your code.

First, let’s look at types of gait:

  • Ataxic: Unsteady or uncoordinated walk;
  • Paralytic: Loss of motor ability while walking;
  • Spastic: Legs held together and moving in a stiff manner;
  • Staggering: Swaying and loss, then recovery, of balance.

If you look in your code book, you see that 781.2 excludes ataxia …. (look up the codes listed to see where you should go for that!) and difficulty walking. Go elsewhere, if that’s what your patient has.

Always remember to look at your category for more instructions … Category 781 EXCLUDES disorders specifically related to: back, hearing, joint, limb, neck, vision, and pain in the limb. If these are the root of the problem, go to the codes indicated to find the correct code; do NOT use 781.2

Start with the exclusions, and you’ll be a better coder.