# V Codes as Primary DX for Medicare



## AmandaM2153

Hey Everyone -- 
I was told by someone that when billing for Medicare you cannot use V codes as a primary DX with an E/M (not routine) -- like say I put a V67.59 follow up surgery and then the issue -- would that be correct or is the V code last?? (Dr did not do surgery)


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## mitchellde

This is an untrue statement.  When providing aftercare from surgery it is incorrect to use the code for the reason for the surgery.  If the condition does not exist then you do not code it.  You would use only the aftercare or follow up code whichever is appropriate.  If the claim does not pay it is not because you used a V code.  If you are providing aftercare for a surgeon and the surgery has a global then if you are in the global an office visit will deny, not because there is a V code but because you billed an office visit for follow up in another physician's global ( you would use the surgical code with the 55 modified).  Some V codes are secondary only and some are first listed only and the rest are allowed either first or second.  
Therefore as long as you are out of the global or are billing global follow up correctly then the only dx code you use is the V67.xx code


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## mitchellde

This is an untrue statement.  When providing aftercare from surgery it is incorrect to use the code for the reason for the surgery.  If the condition does not exist then you do not code it.  You would use only the aftercare or follow up code whichever is appropriate.  If the claim does not pay it is not because you used a V code.  If you are providing aftercare for a surgeon and the surgery has a global then if you are in the global an office visit will deny, not because there is a V code but because you billed an office visit for follow up in another physician's global ( you would use the surgical code with the 55 modified).  Some V codes are secondary only and some are first listed only and the rest are allowed either first or second.  
Therefore as long as you are out of the global or are billing global follow up correctly then the only dx code you use is the V67.xx code


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## JacquelynA

I disagree. I have worked for many specialist including respiratory consultants, cardiologists, pain manangement physicians as well as family practice physicians. It is appropriate to code first the disease or condition and then the procedure,  as in the case of sick sinus syndrome s/p pacemaker implant. The correct way to code it would be 427.81and then V45.04.


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## mitchellde

If the procedure corrects the problem you no longer code it.  Sorry to disagree.  Would you code appendicitis post appendectomy?  If the pacemaker corrects the sick sinus the you do not code it.  It would be an aftercare or follow up encounter whichever the documentation can support.  We must remember this is the patient's encounter and their diagnosis.  If they do not have the problem at this encounter, then we do not code it.


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## AmandaM2153

At one point that's what I had been doing (coding without the diganosis no longer needed but then was told different) -- I'm glad that got clarified. 
The first issue I was having though is someone stating I could not bill a V code primary to Medicare -- it wasn't an if, maybe it was a NEVER!!! Although I question why we provide the modifier if we were not the ones providing the surgery? We do not have a TIN to link us either.


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## mitchellde

AmandaM2153 said:


> At one point that's what I had been doing (coding without the diganosis no longer needed but then was told different) -- I'm glad that got clarified.
> The first issue I was having though is someone stating I could not bill a V code primary to Medicare -- it wasn't an if, maybe it was a NEVER!!! Although I question why we provide the modifier if we were not the ones providing the surgery? We do not have a TIN to link us either.



That is a popular myth but it is only a myth.  V codes mostly are for follow up and after care, and screening, and general exams.  If you are in someone elses global and you do not bill it correctly the the V code is not what causes the claim to fail, it is that the surgeon has been paid for the followup.  If they have no benefits for a certain screening or annual , then it is not the V code that made the claim fail but rather the lack of benefits.  We must be careful when coding as our codes affect the patients long term.


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## gidleyd

*J9031*

My office is giving this with dx V1051, which I got denied by Medicare.
Can you advise how to get the injection paid?
dg


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## mitchellde

What is the injection and what is the reason for the injection?  History of bladder cancer is rarely if ever medical necessity for a therapeutic injection.


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## gidleyd

*J9031*

J9031 is BCG (intravesical) per instillation and I too am not getting this paid with dx V10.51
Donna


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## mitchellde

gidleyd said:


> J9031 is BCG (intravesical) per instillation and I too am not getting this paid with dx V10.51
> Donna


the reason is not the V code it is that it the incorrect dx for that drug.  BCG treats bladder cancer not the history of, you need a current dx not that it is history.


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