CASE #1 Stroke (#1) - hcmarketplace.comhcmarketplace.com/supplemental/1213_CASE_STUDIES_ONLY.pdf ·...
Transcript of CASE #1 Stroke (#1) - hcmarketplace.comhcmarketplace.com/supplemental/1213_CASE_STUDIES_ONLY.pdf ·...
EXHIBIT A
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CASE #1Stroke (#1)
A right-handed 85-year old male has aspontaneous subarachnoid hemorrhage on the leftside of his brain resulting in right (dominant)sided hemiplegia, dysphasia and homonymoushemianopsia. This patient had a cerebralinfarction a year ago from which he has dysphagia(difficulty swallowing) as a late effect. He has hada gastrostomy tube since that time and receivestube feedings.
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CASE #1Stroke (#1)
IRF-PAI
Impairment Group
01.2 Stroke with right body involvement
Etiology
430 Subarachnoid hemorrhage
Comorbid Conditions
784.5 Dysphasia
368.46 Homonymous hemianopsia
438.82 Dysphagia as late effect of prior oldstroke (Tier 2—excluded from RIC 01)
V44.1 Gastrostomy status
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CASE #1Stroke (#1)
UB-92
Principal Diagnosis
V57.89 Admission for rehabilitation with multiple therapies
Additional Diagnosis
438.21 Hemiplegia dominant/late effect CVA
438.12 Dysphasia as late effect of CVA
438.7 Visual disturbance late effect CVA
368.46 Homonymous hemianopsia
438.82 Dysphagia as late effect of prior oldstroke
V44.1 Gastrostomy status
Principal Procedure
96.6 Procedure: Tube feeding
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CASE #2Stroke (#2)
A 75-year old right-handed female suffers acerebral infarction on the right side of her brainresulting in left-sided (non-dominant)hemiparesis, dysphagia (difficulty swallowing)and dysarthria (slurred speech).
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CASE #2Stroke (#2)
IRF-PAI
Impairment Group Code01.1 Stroke with left body involvement
Etiology
434.91 Cerebral infarction
Comorbid Conditions
787.2 Dysphagia
784.5 Dysarthria
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CASE #2Stroke (#2)
UB-92
Principal Diagnosis
V57.89 Admission for rehabilitation with multiple therapies
Additional Diagnosis
438.21 Hemiplegia affecting nondominant sideas late effect of cerebral infarction
438.82 Dysphagia as late effect of cerebralinfarction
438.19 Dysarthria/slurred speech as late effectof cerebral infarction
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CASE #3Non-traumatic Brain Dysfunction
This 62-year old female was independent until afew weeks prior to admission when shedeveloped difficulty ambulating. CT of the headshowed hydrocephalus and she was admitted tothe acute care hospital for placement of aventriculoperitoneal shunt. She is also treated forhypertension and acute renal failure which isresolving. She was transferred to the IRF toregain independence with bed mobility, transfers,
ambulation and self care.
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CASE #3Non-traumatic Brain Dysfunction
IRF-PAI
Impairment Group Code
02.1 Non-traumatic brain dysfunction
Etiology
331.4 Communicating hydrocephalus
Comorbid Conditions
401.9 Hypertension
584.9 Acute renal failure
V45.2 Presence of cerebrospinal fluid drainage device
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CASE #3Non-traumatic Brain Dysfunction
UB-92
Principal Diagnosis
V57.89 Admission for rehabilitation with multiple therapies
Additional Diagnosis
331.4 Communicating hydrocephalus
401.9 Hypertension
584.9 Acute renal failure
V45.2 Presence of cerebrospinal fluid drainage device
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CASE #4Non-traumatic Brain Dysfunction
This is a 60-year old gentleman who sufferedanoxic brain damage as a complication duringhis coronary artery bypass procedure.
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CASE #4Brain Dysfunction
IRF-PAI
Impairment Group Code02.1 Non-traumatic brain dysfunction
Etiology
348.1 Anoxic brain damage
Comorbid Conditions
997.01 Postop central nervous system complication
414.00 Coronary atherosclerosis of unspecifiedtype of vessel, native, or graft
V45.81 Aortocoronary bypass status
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CASE #4Brain Dysfunction
UB-92
Principal Diagnosis
V57.89 Admission for rehabilitation with multiple therapies
Additional Diagnosis
997.01 Postop central nervous system complication
348.1 Anoxic brain damage
414.00 Coronary atherosclerosis of unspecifiedtype of vessel, native, or graft
V45.81 Aortocoronary bypass status
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CASE #5Traumatic Brain Dysfunction
This 45-year old male was in a motorcycle crashand was diagnosed with traumatic brain injuryand right tibial fracture. He had a tracheostomyplaced due to vent-dependent respiratory failure.He was weaned off the vent and transferred tothe IRF for rehabilitation of cognitive deficits andambulation dysfunction. During the IRF stay, thetracheostomy was removed.
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CASE #5
Traumatic Brain Dysfunction
IRF-PAI
Impairment Group Code
02.22 Closed Traumatic Brain Dysfunction
Etiology
854.00 Intracranial injury of other and unspecified nature without mention ofopen intracranial wound with unspecified loss of consciousness
Comorbid Conditions
310.1 Cognitive change due to conditions classified elsewhere
V55.0 Attention to tracheostomy
V54.16 Aftercare for healing traumatic fracture of lower leg
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CASE #5Traumatic Brain Dysfunction
UB-92
Principal Diagnosis
V57.89 Admission for rehabilitation with multiple therapies
Additional Diagnosis
310.1 Cognitive change due to conditions classified elsewhere
907.0 Late effect of intracranial injury without mention of skull fracture
V55.0 Attention to tracheostomy
V54.16 Aftercare for healing traumatic fracture of lower leg
Procedure
97.37 Removal of tracheostomy tube
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CASE #6Neurological Disorders
This is a 50-year old female who has beendiagnosed with Amyotrophic Lateral Sclerosis(a.k.a. Lou Gehrig’s Disease) and whose diseasehas progressed upward to the extent that she nowhas paralysis of both lower limbs. On admissionshe has a pulmonary infiltrate diagnosed in theacute hospital for which she is still on antibioticsand a cystostomy that is being attended to by thenursing staff.
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CASE #6Neurological Disorders
IRF-PAI
Impairment Group Code03.8 Other Neurologic
Etiology
335.20 Amyotrophic Lateral Sclerosis (ALS)a.k.a. Lou Gehrig’s disease
Comorbid Conditions
344.1 Paraplegia
V55.5 Attention to cystostomy
518.3 Pulmonary infiltrate (Tier 3)
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CASE #6Neurological Disorders
UB-92
Principal Diagnosis
V57.89 Admission for rehabilitation with multiple therapies
Additional Diagnosis
335.20 Amyotrophic Lateral Sclerosis (ALS)a.k.a. Lou Gehrig’s disease
344.1 Paraplegia
V55.5 Attention to cystostomy
518.3 Pulmonary infiltrate
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CASE #7Non-traumatic Spinal Cord Dysfunction
The 68-year old female was transferred to theIRF from the acute care facility with paraplegiafollowing surgical removal of metastatic diseasefrom the lumbar vertebrae. The patient had aright mastectomy to treat a breast malignancy inDecember 2005.
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CASE #7Non-traumatic Spinal Cord Dysfunction
IRF-PAI
Impairment Group Code
04.110 Paraplegia, unspecified
Etiology
198.5 Secondary malignant neoplasm of bone
Comorbid Conditions
V10.3 History of breast malignancy
V45.71 Acquired absence of breast
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CASE #7Non-traumatic Spinal Cord Dysfunction
UB-92
Principal Diagnosis
V57.89 Admission for rehabilitation with multiple therapies
Additional Diagnosis
344.1 Paraplegia
V58.42 Aftercare following surgery for neoplasm
V10.3 History of breast malignancy
V45.71 Acquired absence of breast
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CASE #8Non-traumatic Spinal Cord Injury
This is a 65-year old gentleman who has severelumbar degenerative disc disease with spinal cordimpingement and subsequent paraplegia who isafraid to have surgery due to a poor history ofhealing due to his advanced type 2 diabetes. Hisefforts in outpatient rehab have met with limitedsuccess. He is admitted now for multipletherapies under medical supervision as well ascontinued treatment for his diabetic neuropathyto maintain his muscle mass and to attempt torelieve his pain.
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CASE #8Non-traumatic Spinal Cord Injury
IRF-PAI
Impairment Group Code04.110 Non-traumatic spinal cord with
paraplegia, unspecifiedEtiology
722.73 Lumbar DDD with myelopathy
Comorbid Conditions
250.60 Type 2 diabetes with neurologic manifestation
357.2 Polyneuropathy and diabetes
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CASE #8Non-traumatic Spinal Cord Injury
UB-92
Principal Diagnosis
V57.89 Admission for rehabilitation with multiple therapies
Additional Diagnosis
722.73 Lumbar DDD with myelopathy
250.60 Type 2 diabetes with neurologic manifestation
357.2 Polyneuropathy and diabetes
344.1 Paraplegia
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CASE #9Traumatic Spinal Cord Dysfunction
This 45-year old male was transferred to the IRFfor rehabilitation of T-8 fracture with paraplegiafollowing a fall from a 2nd story porch. He has aneurogenic bladder and a history of hypoxia dueto sleep apnea.
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CASE #9Traumatic Spinal Cord Dysfunction
IRF-PAI
Impairment Group Code
04.210 Paraplegia, unspecified
Etiology
806.25 T-8 fracture with unspecified spinalcord injury
Comorbid Conditions
596.54 Neurogenic bladder
780.57 Sleep apnea
327.24 Sleep related hypoxia
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CASE #9Traumatic Spinal Cord Dysfunction
UB-92
Principal Diagnosis
V57.89 Admission for rehabilitation with multiple therapies
Additional Diagnosis
344.1 Paraplegia
907.2 Late effect of spinal cord injury
596.54 Neurogenic bladder
780.57 Sleep apnea
327.24 Sleep related hypoxia
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CASE #10Unilateral Knee Amputation
This is a 55-year old who was admitted followingan above the knee amputation due to type 2diabetic arteriosclerotic peripheral vasculardisease with gangrene. He also suffers fromdiabetic neuropathy.
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CASE #10Unilateral above the knee amputation
IRF-PAI
Impairment Group Code05.3 Unilateral above knee amputation (AKA)
Etiology
440.24 Arthrosclerosis of the extremities withgangrene
Comorbid Conditions
250.70 Type 2 diabetes with peripheral circulatory disorders
250.60 Type 2 diabetes with neurological manifestation
357.2 Polyneuropathy in diabetes
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CASE #10Above the knee amputation
UB-92
Principal Diagnosis
V57.89 Admission for rehabilitation with multiple therapies
Additional Diagnosis
V58.49 Other specified aftercare following surgery
V49.76 Status above knee amputation (AKA)
250.70 Type 2 diabetes with peripheral circulatory disorders
440.20 Arthrosclerosis of the extremities250.60 Type 2 diabetes with neurological
manifestation
357.2 Polyneuropathy in diabetes
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CASE #11Rheumatoid Arthritis
This is a 75-year old patient who suffers withrheumatoid arthritis complicated by morbidobesity. She has a history of a total hipreplacement in the past.
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CASE #11Rheumatoid Arthritis
IRF-PAI
Impairment Group Code06.1 Rheumatoid Arthritis
Etiology
714.0 Rheumatoid Arthritis
Comorbid Conditions
278.01 Morbid obesity (Tier 3)
V43.64 Prosthetic hip joint
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CASE #11Rheumatoid Arthritis
UB-92
Principal Diagnosis
V57.89 Admission for rehabilitation with multiple therapies
Additional Diagnosis
714.0 Rheumatoid Arthritis
278.01 Morbid obesity
V43.64 Prosthetic hip joint
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CASE #12Osteoarthritis
This is a 75-year old female who suffers fromosteoarthritis of multiple sites (shoulders, hips,knees, fingers) who, due to her arthritis, is losingher mobility. She also suffers from a slowbleeding chronic stomach ulcer from years oftaking NSAIDS for her arthritis and as a resultalso has chronic blood loss anemia. She isadmitted now for multiple therapies to increaseher mobility and build up her strength whilereceiving medical supervision of her ulcer andanemia.
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CASE #12Osteoarthritis
IRF-PAI
Impairment Group Code06.2 Osteoarthritis
Etiology
715.89 Osteoarthritis involving multiple sites,not specified as generalized
Comorbid Conditions
531.40 Chronic stomach ulcer with hemorrhage(Tier 3)
280.0 Chronic blood loss anemia
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CASE #12Osteoarthritis
UB-92
Principal Diagnosis
V57.89 Admission for rehabilitation with multiple therapies
Additional Diagnosis
715.89 Osteoarthritis involving multiple sites,not specified as generalized
531.40 Chronic stomach ulcer with hemorrhage
280.0 Chronic blood loss anemia
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CASE #13Systemic Vasculidities
This is a 45-year old female who has suffered arecent exacerbation of her systemic lupuserythematosus. She also suffers from Raynaud’sdisease which has also been more of an issuerecently due to her increased stress over thisrecent flare up of her SLE.
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CASE #13Systemic Vasculidities
IRF-PAI
Impairment Group Code06.9 Other Arthritis
Etiology
710.0 Systemic Lupus Erythematosus
Comorbid Conditions
443.0 Raynaud’s phenomenon
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CASE #13Systemic Vasculidities
UB-92
Principal Diagnosis
V57.89 Admission for rehabilitation with multiple therapies
Additional Diagnosis
710.0 Systemic Lupus Erythematosus 443.0 Raynaud’s phenomenon
108
CASE #14Hip Fracture
This is a 85-year old gentleman who twisted hisleg and fell backwards while carrying out thegarbage. He suffered a subcapital hip fracturerequiring a hip replacement. His postoperativecourse was further complicated by a femoraldeep vein thrombosis for which he is undergoingtreatment as well while in rehab.
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CASE #14Hip Fracture
IRF-PAI
Impairment Group Code08.11 Status Post Unilateral Hip Fracture
Etiology
820.09 Subcapital hip fracture
Comorbid Conditions
V43.64 Status prosthetic hip joint
453.41 Femoral deep vein thrombosis (DVT)(Tier 3)
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CASE #14Hip Fracture
UB-92
Principal Diagnosis
V57.89 Admission for rehabilitation with multiple therapies
Additional Diagnosis
V54.81 Aftercare following joint replacement
V43.64 Status prosthetic hip joint
997.2 Postop peripheral vascular complication
453.41 Femoral deep vein thrombosis (DVT)
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CASE #15Multiple Fractures
This 76-year old male was an unrestrained driverin an automobile that hit a tree. He sustainedclosed fractures of the left tibia, left fibula andleft humerus. He has a history of hypertensionand COPD.
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CASE #15Multiple Fractures
IRF-PAI
Impairment Group Code
08.4 Major multiple fractures
Etiology
828.0 Multiple fractures involving lower withupper limb
Comorbid Conditions
496 COPD
401.9 Hypertension unspecified
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CASE #15Multiple Fractures
UB-92
Principal Diagnosis
V57.89 Admission for rehabilitation with multiple therapies
Additional Diagnosis
V54.16 Aftercare for healing traumatic fracture of lower leg
V54.11 Healing traumatic fracture of upperarm
496 COPD
401.9 Hypertension
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CASE #16Bilateral Knee Replacements
This 53-year old female has suffered for yearswith painful osteoarthritis in both knees. Shebegan to lose her mobility to the point thatbilateral knee replacements were her only option.Mary also has a history of combined systolic anddiastolic hear failure that flared up after surgeryfor which she is still receiving treatment.
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CASE #16Bilateral Knee Replacements
IRF-PAI
Bilateral Knee Replacements08.62 Status Post Bilateral Knee Replacements
Etiology
715.36 Osteoarthrosis, localized, not specifiedwhether primary or secondary, lower leg
Comorbid Conditions
428.40 Combined systolic and diastolic heartfailure, unspecified (Tier 3)
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CASE #16Bilateral Knee Replacements
UB-92
Principal Diagnosis
V57.89 Admission for rehabilitation with multiple therapies
Additional Diagnosis
V54.81 Aftercare following joint replacement
V43.65 Status prosthetic knee joint(s)
428.40 Combined systolic and diastolic heartfailure, unspecified
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CASE #17Burns
This 19-year old college student, sprayed hisaerosolized hair spray at a lit cigarette lighter.The ensuing large flame ignited his clothing. Hesuffered third degree burns on his hair, face,chest, trunk, right arm, and both legs. Hesuffered smoke inhalation from the subsequentfire in his dorm room and acute pulmonaryedema due to the fumes and vapors of the othermaterials burning in his room. Due to the smokeinhalation and burns he is also suffering from
dysphagia.
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CASE #17Burns: Impairment Group 11
IRF-PAI
Impairment Group Code11 Burns
Etiology
948.53 Burns over 50% body; 30-39% of whichare third degree
Comorbid Conditions
946.3 Third-degree burns of multiple sites
987.9 Smoke inhalation
787.2 Dysphagia (Tier 2)
506.1 Acute Pulmonary Edema due to fumes/vapors (Tier 3)
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CASE #17Burns
UB-92
Principal Diagnosis
V57.89 Admission for rehabilitation with multiple therapies
Additional Diagnosis
948.53 Burns over 50% of body surface, 30-39% of which are third-degree burns
946.3 Third-degree burns of multiple sites
987.9 Smoke inhalation
787.2 Dysphagia
506.1 Acute Pulmonary Edema due to fumes/vapors
E891.2 Hotel building fire
E849.6 Hotel
Principal Procedure
86.22 Surgical debridement
86.28 Nonexcisional debridement
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CASE #18Congenital Deformities
This 14-year old was born with congenitalhemiplegic cerebral palsy which also resulted indysphagia. He has acquired contractures of bothhis lower left leg and left forearm. John also hasa urinary tract infection due to pseudomonas forwhich he is on antibiotic. John is admitted formultiple therapies as well as botox injections forhis contractures.
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CASE #18Congenital Deformities
IRF-PAI
Impairment Group Code12.9 Other Congenital Deformities
Etiology
343.1 Cerebral Palsy—hemiplegia
Comorbid Conditions
787.2 Dysphagia (Tier 2)
718.46 Acquired joint contracture—lower leg
718.43 Acquired joint contracture—forearm
599.0 UTI
041.7 Pseudomonas (Tier 2)
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CASE #18Congenital Deformities
UB-92
Principal Diagnosis
V57.89 Admission for rehabilitation with multiple therapies
Additional Diagnosis
343.1 Cerebral Palsy—hemiplegia
787.2 Dysphagia
718.46 Acquired joint contracture—lower leg
718.43 Acquired joint contracture—forearm
599.0 UTI
041.7 Pseudomonas
Principal Procedure
04.2 Botox injection
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CASE #19Major Multiple Trauma
This 56-year old was in a 2-car MVA in which hesuffered a closed head injury with subarachnoidhemorrhage and prolonged loss of consciousnesswith eventual return to his pre-existing state. Heis on antibiotics for aspiration pneumonia. He hashemiplegia, dysphagia, aphasia, and cognitivedeficits due to his head injury and is receivingaftercare for fractures of his hip, tibia and fibula.He has a tracheostomy and, although conscious,is stuporous or drowsy. He is admitted formultiple therapies and extensive acute rehab.
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CASE #19Major Multiple Trauma: Brain & multiple fracturesImpairment Group: 14.2
IRF-PAI
Impairment Group Code14.2 Major Mult Trauma—Brain and Spinal Cord
Etiology
852.04 Closed head injury SAH/prolonged LOC and return to pre-existing state
Comorbid Conditions
342.90 Hemiplegia
787.2 Dysphagia
784.3 Aphasia
310.1 Cognitive deficit
507.0 Aspiration Pneumonia (Tier 3)
V54.13 Aftercare fx hip
V54.16 Aftercare fx tibia/fibula
V55.0 Attention to tracheostomy (Tier 1)
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CASE #19Major Multiple Trauma
UB-92
Principal Diagnosis
V57.89 Admission for rehabilitation with multiple therapies
Additional Diagnosis
342.90 Hemiparesis
787.2 Dysphagia
310.1 Cognitive deficit
780.09 Drowsiness, stupor
907.0 Late effects of closed head injury
507.0 Aspiration Pneumonia (on meds)
V54.13 Aftercare of hip fracture
V54.16 Aftercare of fractured tibia/fibula
V55.0 Aftercare of tracheostomy
E929.0 Late effect of motor vehicle accident