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ICD-10 Scenario: Joint replacement, anxiety

A 75-year-old woman underwent a knee replacement to treat osteoarthritis that was stated to be localized to the knee that was replaced, which is her left knee. She will receive skilled nursing and physical therapy. She has severe generalized anxiety disorder, for which she has been prescribed new medications.

Code the scenario:

Primary and Secondary Diagnoses		M1025 Additional diagnoses
M1021: Aftercare following joint replacement surgery	Z47.1
M1023: Generalized anxiety disorder	F41.1
M1023: Presence of left artificial knee joint	Z96.652

Rationale:

• ● The focus of care is the aftercare following the joint replacement, which is captured with Z47.1.
• ● Her anxiety diagnosis was specified as generalized anxiety disorder and thus is coded as such.
• ● Since the osteoarthritis was said to be localized to the knee that was replaced, it is a resolved condition and thus is not coded.
• ● The presence of the artificial knee is also captured, with Z96.652.
• ● In ICD-9, codes for this scenario would be assigned in the following order: V54.81 (Orthopedic aftercare following joint replacement), 300.02 (Generalized anxiety disorder) and V43.65 (Organ or tissue replaced by other means, knee joint).

ICD-10 Scenario: Colostomy, Crohn’s disease, depression

A 70-year-old woman had surgery 10 days ago to place a colostomy as the result of a severe flare of her Crohn’s disease that caused an abscess. The abscess is now resolved. However, as a result of the colostomy, she has been severely depressed. She was admitted to home health for surgical aftercare, for teaching on the care of the colostomy and about depression and the antidepressant medication she was recently prescribed.

Code the scenario:

Primary and Secondary Diagnoses		M1025 Additional diagnoses
M1021: Encounter for surgical aftercare following surgery on the digestive system	Z48.815
M1023: Encounter for attention to colostomy	Z43.3
M1023: Crohn's disease, unspecified, without complications	K50.90
M1023: Major depressive disorder, single episode, unspecified	F32.9

Rationale:

• ● As the focus of care, the surgical after is coded in M1021. Directly following it is the care and teaching of the colostomy, coded with Z43.3.
• ● Crohn’s disease, which is the reason for the placement of the colostomy, is sequenced next. While the Crohn’s was recently complicated by an abscess, the abscess was resolved by the colostomy. Thus, it is coded as uncomplicated.
• ● Depression is coded because it has the potential to impact the patient’s recovery and her ability to learn to care for her new colostomy. Furthermore, there are no more pertinent diagnoses requiring monitoring that will take up spaces in top six and thus F32.9 is coded in M1023.
• ● In ICD-9, the codes for this scenario would be assigned in the following order: V58.75 (Aftercare following surgery of the teeth, oral cavity and digestive system, NEC), V55.3 (Attention to colostomy), 555.9 (Crohn’s disease NOS) and 311 (Depression NOS).

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