K. Admissions/Encounters for Rehabilitation
When the purpose for the admission/encounter is rehabilitation, sequence first the code for the condition for which the service is being performed. For example, for an admission/encounter for rehabilitation for right-sided dominant hemiplegia following a cerebrovascular infarction, report code I69.351, Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side, as the first-listed or principal diagnosis.
If the condition for which the rehabilitation service is no longer present, report the appropriate aftercare code as the first-listed or principal diagnosis, unless the rehabilitation service is being provided following an injury. For rehabilitation services following active treatment of an injury, assign the injury code with the appropriate seventh character for subsequent encounter as the first-listed or principal diagnosis. For example, if a patient with severe degenerative osteoarthritis of the hip, underwent hip replacement and the current encounter/admission is for rehabilitation, report code Z47.1, Aftercare following joint replacement surgery, as the first-listed or principal diagnosis. If the patient requires rehabilitation post hip replacement for right intertrochanteric femur fracture, report code S72.141D, Displaced intertrochanteric fracture of right femur, subsequent encounter for closed fracture with routine healing, as the first-listed or principal diagnosis.
Yes, I specialize in IRF coding, clinical documentation and revenue cycle process and have been teaching this method already, great to see it in print. BUT remember the IRF-PAI which is the document that sets the payment rate for Medicare claims is not coded the same way the UB04 claim form is coded. So, for Medicare cases even though we are coding the UB-04 in this method, it is not the payment driver. Often there is miss-communication regarding this point and it causes struggles between the IRF-PAI Coordinator and HIM Coder.
Paula Digby, CCS, CDIP, CPC, CPCI, AHIMA Approved ICD10-CM/PCS Trainer
AQ Consulting, LLC and AQ-IQ.com