ICD-9 Codes

It is well know that the ICD9 system does a very poor job at describing the patient is receiving our services.  I use multiple ICD9 codes to assist in painting the picture for the insurance companies, reviewers, etc.  For example, a patient s/p TKA I will use several - 719.46, 719.56, 719.7, 715.16, V43.65, etc.  The problem with the ICD9 system is that it is not possible just by using the codes to determine the severity of the individuals dysfunction.  There could be 2 individuals for which I use those same codes but one could require only a month of treatment and the other 3-4 months.  The limitation in this system is probably the push behind the Medicare G-codes for claims based functional limitation reporting.  You often hear from Medicare that they don't know who is receiving what and why.

I believe it is ultimately the responsibility of the PT to determine the diagnosis and code appropriately.  I agree that having a coders assistance can be valuable but I am not clear how they can review documentation and choose diagnosis codes - that is the responsibility of the clinician.

In your example above, I agree that using a code such as 596.0 in isolation would most likely not be a wise decision on the part of the clinician as it does not assist in painting a clear picture to the payor and/or reviewer.  Now using 596.0 along with V15.88, 728.87, and 788.31 (incontinence) could help pain the picture of patient with bladder dysfunction contributing to incontinence, and a history of falls and muscle weakness associated with the bladder dysfunction, possibly from prolonged immobilization or attempts to get up in the night to void and contributing to falls.

I encourage my staff to pain as clear a picture as possible through the use of the ICD9.  As time moves on, progressing to newer classification systems such as ICD10, ICF, functional reporting and the Alternative Payment System will help paint a much clearer picture.