M1017
If a patient has had a total joint replacement is the osteoarthritis included in M1017? I thought that I read to include it in M1017, as the care provided is for the joint replacement. I understood this to be an exception to the rule, that if the condition has resolved it is not included in M1017.
Comments
Since we can't put in a Z code to indicate the joint replacement, I believe we do use the OA code in M1017. That's what I do and I also did a little research in this forum & it looks like that's what others said as well.
yes we code the OA for the M1017 and we code the aftercare for the M1021
No, the OA of the knee will NOT be included in the 1017. if the patient had a total joint replacement, the OA has been "resolved" the diseased knee is no longer there, and we do not report resolved conditions in the 1017. it will be reported in the 1011 only.
We had an outside audit and we were instructed that M1017 should have the OA code
Hmmmm, we have NEVER put OA in M1017. No resolved conditions, only new or exacerbated.
"If at any time in the last 14 days the patient requires a medical or treatment regimen change due to development of a new condition or lack of improvement or worsening of an existing condition, the diagnosis should be reported in M1017, even if the condition also showed improvement or stabilization during that time, or is improved at the time of SOC/ROC."
This came straight from a powerpoint slide from Lisa Selman-Holman. If the condition resolved prior to the 14 day window then we don't code it, even if they were treated in the hospital. But, if the condition was present within those 14 days, then we do.
OA (applicable to the joint being replaced) , is considered no longer present/resolved (unless the physician states otherwise) after the joint is replaced. OA, for the joint replaced would not be used in M1017.
IE: M1011: M17.11 Unilateral primary osteoarthritis, right knee
M1017: R26.9 Unspecified abnormalities of gait and mobility
"If at any time in the last 14 days the patient requires a medical or treatment regimen change due to development of a new condition or lack of improvement or worsening of an existing condition, the diagnosis should be reported in M1017, even if the condition also showed improvement or stabilization during that time, or is improved at the time of SOC/ROC."
THE CONDITION NO LONGER EXISTS the actual OA did not improve or stabilize, it is resolved . The pain or gait could have improved/stabilized if still present, so we use gait or pain if applicable in M1017.
The condition treated is not entirely resolved, ie..the pt still has the effects of the surgical procedure, would you not put the dx for which the pt had the procedure? The joint was indeed removed, but that remains the reason the pt had the surgery.