# no longer congenital



## cdavis022972 (Jul 24, 2014)

Patient had a PFO, in 11/2013. patient came in for follow up visit 7/2014 echo was performed and PFO was closed. Since there was a congenital anomally in the past and this Echo is to check for PFO is this 2014 echo a congenital echo??


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## Dialmam (Jul 29, 2014)

We struggle with this as well.  Since last visit, there was a PFO, your dx still would be PFO.  However, because it was closed on this visit and the report states, no longer seen, I would bill it as normal, not congenital. 

Some physicians in my practice bill either way - but I think it is misleading to use a congenital code if the report states no anomalies found.


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## mitchellde (Jul 29, 2014)

This is just a follow up following a procedure you use a V code for follow up and not a disease code, you the coder cannot change a healed congenital condition to an acquired condition, these are two entirely different disease processes.


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## cdavis022972 (Jul 30, 2014)

That's what I thought, but I wanted to make sure. Thanks so your Help!


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## Dialmam (Jul 31, 2014)

Mitchellde - from your response, are you saying that for a f/u visit where a PFO was found closed, you would use V13.65 and also the congenital echo?  Doesn't that seem conflicting?


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## mitchellde (Jul 31, 2014)

No I am saying use a V67 code for follow up with the V 13.65 as a secondary, you cannot code this as an acquired condition.


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## Dialmam (Jul 31, 2014)

Mitchellde - I really appreciate your responses but I am still confused...

V67 is for follow up of completed treatment..but sometimes the PFO spontaneously closes.  Patient will come back 1-2 years later to check that PFO and it's closed - no treatment done.  So you are saying you would use 
V67.9 and V13.65  and bill a normal (not congenital) echo?


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## mitchellde (Jul 31, 2014)

I took the original post to indicate this was after a procedure to close the defect.  If the defect closed on its own then again there is no longer a defect present so the dx code will be the history of the congenital defect with a plain echo procedure.


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## Dialmam (Aug 1, 2014)

That is what I understand as well.  Thanks!!


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## theresa.dix@tennova.com (Aug 6, 2014)

mitchellde said:


> I took the original post to indicate this was after a procedure to close the defect.  If the defect closed on its own then again there is no longer a defect present so the dx code will be the history of the congenital defect with a plain echo procedure.



We just had this scenario yesterday. I had remembered a discussion about this. And then we have this problem. The followup V code is not a covered dx.
 So I am sure that would get denied. There has to be a way to code these for payment since it is medically nescessary.


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## mitchellde (Aug 6, 2014)

The follow up dx should be covered,  there is no other dx code you can use.  Do you have it in writing from the payer that the V code for follow up is non covered?


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## theresa.dix@tennova.com (Aug 8, 2014)

mitchellde said:


> The follow up dx should be covered,  there is no other dx code you can use.  Do you have it in writing from the payer that the V code for follow up is non covered?


Michelle,
I have the LCD for our MAC. Unless this is for commercial then I do not have it in writing.But most likely they would follow medicare LCD.
This has been an ongoing problem. And no one really knows exactly how to code these. I have asked for years different consultants. The only thing I can think to do is code the condition and status post v45.89 for the closure if surgery was done.


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## mitchellde (Aug 8, 2014)

You cannot code a condition that does not exist at the time of the encounter.  The diagnosis is the patient's not your clinic's.  You must use a follow up V code first listed and then the other V for status post and or history of the condition.  There is no other compliant, acceptable  way to code these.  There should be no problem with payment, i have coded visits like these and they have never been denied.   If it is denied for medical necessity then appeal as they have an incorrect edit.


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## Misty Dawn (Aug 10, 2014)

Just a note you should not be using the congenital echo codes (93303, 93304 and 93315-93317) for a Patent Foramen Ovale (PFO) regardless if it is closed or not.   This is in the 2013 CPT Reference Guide for cardiovascular coding AMA/ACC.   They list examples of "simple" congenital anomalies such as PFO & Bicuspid aortic valve should be coded with the non-congenital echo codes. For coding/billing purposes these are not coded with congenital echos.


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