We have a resident who we are skilling related to a recent femur fracture. The principal diagnosis is S72.22XD, which maps to the Non-Surgical Orthopedic/Musculoskeletal Clinical Category, but it states “May be Eligible for One of the Two Orthopedic Surgery Categories”. How do we determine if it is eligible for one of the Orthopedic Surgery categories?
If it is a diagnosis that mapping states may be eligible for 1 of the 2 Orthopedic Surgery Categories, which applies to S72.22XD when one of the following criteria is met:
- If any of the procedures indicated in items J2300, J2310, J2320, J2330, J2400, J2410, or J2420 was performed during the prior inpatient stay, then the resident is categorized into the major joint replacement or spinal surgery clinical category.
- If any of the procedures indicated in items J2500, J2510, J2520, or J2530 was performed during the prior inpatient stay, then the resident is categorized into the Orthopedic Surgery (Except Major Joint Replacement or Spinal Surgery) clinical category.
Shelly Maffia RN, MSN, MBA, LNHA, QCP, CHC, CLNC, CPC
Director of Regulatory Services
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