Coding, Classification & Reimbursement

1.  Broke bone

Posted 06-19-2017 07:26
​I code for a VA and I was wondering if they leave the hospital and go to the nursing home the day after they have surgery to repair a broken bone. Do I need to code the brake as initial, subsequent for insurance. It is still actively been treated. The staples from the repair are still present.

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Kimberly Golden
Medical Records Tech/Coder
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2.  RE: Broke bone

Posted 06-20-2017 10:23
Dear Kimberly,

Since you code for the VA and the VA performed the surgery, then you would code initial treatment. Let the nursing home worry about their own coding.

Jodi Miller, RHIT, CCS

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Jodi Miller, RHIT, CCS
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3.  RE: Broke bone

Posted 06-20-2017 13:39
​It is a VA nursing home I am doing the profees for. So I am unsure if when billing the profees it needs to be initial or subsequent.

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Kimberly Golden
Medical Records Tech/Coder
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4.  RE: Broke bone

Posted 06-21-2017 10:46
Dear Kimberly,

Oh I am so sorry that I misunderstood you actual position and responsibilities.

The VA hospital would code initial. As far as the nursing home, what is the plan? Is the patient getting rehab? If so that is part two of the treatment and would get a subsequent. If the patient is just convalescing until the follow-up appointment then I would say initial because he is still in the first part of treatment.

Jodi Miller, RHIT, CCS

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Jodi Miller, RHIT, CCS
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5.  RE: Broke bone

Posted 06-20-2017 20:24
Once in the SNF or LTC milieu, the fracture would be a "D" code because it is aftercare for the initial treatment when the bone was set or diagnosed (the A code phase).  It's a very common error in long-term care.

The oddest thing about tje inpatient rehab that some are talking about above is that you have to code it twice, once in the IRF-PAI as a kind of continuum of initial care, so the etiology is an A code diagnosis, yet on the UB you code it as if it were SNF with a D code.  Has taken some getting used to.

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Autumn L. Kruer, RHIT
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6.  RE: Broke bone

Posted 06-20-2017 20:40
VA guidelines state when patient is admitted to VA nursing home, 7 character is D subsequent with routine healing

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Mark Miller
MRT CDIS
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