Q:
One of our long-term residents fell and fractured their femur requiring a hip replacement. They returned to our facility on a skilled stay. The IDT met and were discussing a primary diagnosis. Therapy believes we should use Z47.1 Aftercare following joint replacement surgery but some of the available hospital documentation uses S72.141A Displaced intertrochanteric fracture of right femur, initial encounter for closed fracture. Which is the correct code?
A:
In this case, neither is correct, but the S72.141A is close.
According to the ICD-10-CM Official Guidelines for Coding and Reporting FY2024 (p. 98): “The aftercare Z codes should not be used for aftercare for injuries. For aftercare of an injury, assign the acute injury code with the appropriate 7th character.” Additionally, p. 76 reads, “The aftercare Z codes should not be used for aftercare for conditions such as injuries or poisonings, where the 7th characters are provided to identify subsequent care. In essence, the 7th character serves the same purpose as the aftercare Z code in care of injuries. In this example, the acute injury code is S72.141.
The hospital is the initial site of service for the treatment of this fracture and they correctly assigned the “A” as the 7th character to identify the initial encounter of active care. This indicates an “encounter where the patient is receiving active treatment for the condition” (p. 76). The SNF is providing rehabilitation following the initial treatment. For this the “D” code should be used indicating “the patient has completed active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase” (p .76). The appropriate primary diagnosis, then, is S72.141D.
Your Therapy team may be concerned that the use of the fracture code will not result in the major joint replacement clinical category for PT/OT that is achieved by assigning the aftercare following a joint replacement (Z47.1) code. You can reassure therapy that by correctly assigning the fracture code as primary and coding the surgery as a joint replacement and not a fracture repair in section J of the MDS, the Major Joint Replacement clinical category will result based on the PDPM clinical mapping files.
Have documentation and coding questions? Contact us to learn more about a Proactive flat rate annual partner plan for MDS accuracy and clinical support.
Chris Calo, RN, BSN, RAC-CT
Consultant
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