Elixir Medical Claims Management LLC

Know how ICD-10-CM sequencing changes will affect rehabilitation services

ICD-10-CM guidelines Section II. Selection of Principal Diagnosis K. state that when patients undergo rehabilitation services, the principal diagnosis is the condition for which the rehabilitation is performed. Note that this is the opposite of ICD-9-CM guidelines, which require coders to report a code from category V57 as the principal diagnosis followed by a code to denote the condition for which the rehabilitation is performed.
Consider this ICD-10-CM scenario: A patient presents with left-sided (dominant) hemiplegia followed a cerebrovascular accident. Report I69.352 (hemiplegia and hemiparesis following cerebral infarction affecting left dominant side) as the principal diagnosis.
If the condition for which the rehabilitation is performed is no longer present, ICD-10-CM coding guidelines state that coders must report an aftercare code as the principal diagnosis.
Consider this ICD-10-CM scenario: A patient presents for rehabilitation services following a hip replacement. The patient underwent the hip replacement due to severe degenerative osteoarthritis that no longer exists thanks to the surgery. Report Z47.1 (aftercare following joint replacement surgery) as the principal diagnosis.
Coders must pay close attention to the specific diagnosis for which the rehabilitation services are performed and whether the patient still has this condition. Physician education is going to be very important for these cases.