Coding Scenario: Degenerative changes in hips & knees

An 82-year-old woman is referred to home health for physical and occupational therapy due to severe degenerative changes in both hips and both knees. She suffers from depression and anxiety and has refused joint replacement surgery. Additional comorbidities include hypertension and chronic atrial fibrillation, for which she takes Coumadin. She reports that she experiences joint pain on a daily though not constant basis but is able to remain relatively comfortable as long as she avoids walking too much or taking the stairs. Item M1242 is marked with “3.”


Code the scenario:

Additional diagnosis: Z79.01 (Long term (current) use of anticoagulants)

Rationale:

• Code the reason for this patient’s home health admission, osteoarthritis in her hips and knees, in the primary slot and in M1023b.
• Code for degenerative changes in the hips and knees as osteoarthritis, according to Q2 2018 Coding Clinic guidance.
• The patient’s hypertension and atrial fibrillation are relevant comorbidities that could impact her recovery. Code for them as secondary diagnoses.
• Depression and anxiety are both present but can’t be presumed connected unless the physician links them. Code for these conditions separately.
• The patient’s use of anticoagulant medication comes with certain risks. Capture this medication status with Z79.2.

The fact that the patient can manage the pain caused by her severe arthritis as long as she restricts her activity does not mean that the patient is not experiencing pain that interferes with activity, according to OASIS Q&As.