# What's the Primary DX when V43.3 is 2nd?



## Orthocoderpgu (Dec 17, 2009)

Patient had a heart valve replaced (V43.3) and is on blood thinners (V58.61) so the patient has to have their INR checked frequently. When they come in for the protime to check the INR, what code is listed as the primary DX since both of these codes state that they have to be 2nd and can't be used as a primary DX code? Thanks for your suggestions !


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## dimmitta (Dec 17, 2009)

*Primary Dx when V43.3 is 2nd*

If the patient has no current problems you could probably use a V12.5X which is allowed to be primary dx then put the V43.3. This would show that the patient had a history of cardiovascular disease and subsequently had a heart valve replaced.


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## kevbshields (Dec 17, 2009)

Is the patient on blood-thinners?  That is the most common reason for monitoring after the valve replacement surgery that I've seen.  If so, and that is the reason for monitoring, then actually V58.83, V58.61, etc, etc are used.

There is a Coding Clinic that covers this topic, but we'd need more information before finalizing a recommendation.


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## mitchellde (Dec 17, 2009)

Kevin is correct  it is the V58.83 first, V58.61, the your V43.x


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