Posts tagged ‘colostomy’

July 16, 2011

Read on … this patient has something for everyone

Question:  This gentleman has six pressure ulcers total, 2 of which are unstageable and 4 of which are a stage 4.  I have coded each pressure ulcer by location and stage already and the primary diagnosis as aftercare following surgery because he had surgical debridement of these while in the hospital prior to admission onto services. I feel that is correct, but you may think differently.
He was diagnosed with severe osteo while in the hospital and also had debridement of the bone as well as the wounds. He is on po levaquin now in the home and was discharged with dx of osteo, so I am assuming that the surgical debridement and IV antibiotics while in the hospital did not rectify it all.  So, I am not sure how to add the dx it into the sequence of the pressure ulcers, maybe secondary, but not quite sure on that.

educating and providing care to this as well.  So, I know that I need to add “colostomy status (v44.3)” and “attn to colostomy, (v55.3)” in the sequence. Our primary focus in the home of course is the wounds, but the colostomy is very important as well, so do I sequence it under the wounds? The wounds just take up so much in the coding scenario that I do not want the colostomy to get missed or I put it too far down in the “line up”.

I am still unclear how to code for supplies on this and we will be providing to him his colostomy supplies.

He is a paraplegic (344.1), so of course I will code that and he also was diagnosed sarcodosis (136.5?) leukocytosis (288.60) and malnutrition (236.9?).

Lisa says: Because you have several stage 4s code the locations and then add the 707.24 for stage 4. I would then code the paraplegia. The V code for attention to colostomy can be used as the 6th diagnosis if you feel strongly that it needs to be coded in the top six. NEVER code the status and attention to codes for the same ostomy at the same time. 
Add the other codes in any order keeping in mind that the other two ulcers are coded as unstageable. 
I would not code aftercare in this situation at all. You are not really providing aftercare. 
Other general reminders: the same code cannot be used more than once so there is no way to code two ulcers at the same site nor is there any way to code bilateral ulcers. 
Non routine supply points in this case are obtained from how M1630 (bowel ostomy), M1308 and M1324 (pressure ulcers) are answered, not on the codes. This scenario is getting a LOT of NRS points so ensure that the appropriate revenue codes and charges are added to your final bill and your HIPPS code ends in a letter (provided supplies). 
June 13, 2011

Doozie of a coding case

Question: We have a doozie of a patient.
He was discharged from an inpatient stay at the hospital for abscess under the right axilla for which he had an I&D.  We are seeing him for wound care following this procedure.  The wound is clean now without any infection presently.  He also had a pulmonary embolism that was treated in the hospital with lovenox and Coumadin.  He is still on Coumadin, of course, and this affects his dressing changes as he bleeds quite a bit during the dressing changes. Plus we will be monitoring his PT/INRs of course. He also has LE DVT.

The primary reason that we are seeing him is the wound care.

He is a type 2 diabetic (fairly recently diagnosed) and just started on Levamir while in the hospital. This may delay wound healing, so I know that it needs to be pretty up in the diagnosis chain.

Past history includes CA of the appendix (which has been removed surgically), but this metastasized to the abdomen (does not give specific organ, but I am assuming colon because he has a colostomy) and the lung. He is independent with his colostomy, so I know not to code “ATTN TO” on this one. He also has hx of prostate CA as well.

His cancer is still active as he is on chemotherapy.  It is just on hold related to the fact that he had the abscess.

He is morbidly obese, has HTN (with several meds) and GERD.

I am in desperate need of assistance on this one.

Lisa says: He’s a doozie all right!! I think I would still code the wound as an abscess. Follow with the PE, DVT, diabetes, HTN, secondary site(s) of Ca. Follow with V58.83, V58,61, V44.3 and the rest of the codes. Once you’ve coded the primary, you just have to consider the seriousness of the other conditions and importance to the POC. Push your V codes to the bottom.