2004 ICD-9 Update: Use New V Codes for All Insulin Pump Visits

If your endocrinologist is using insulin pumps for Type I diabetics, you should know how to use three new codes (V45.85, V53.91, V65.46) to improve reimbursement for your physician's insulin pump-related services.

The recent increase in insulin pump use created a need for the new insulin pump V codes, which went into effect Oct. 1, 2003. ICD-9 includes a V codes section to help you code for patients with already-existing diseases and conditions, as well as for various treatment regimens and extenuating circumstances.
Justify Insulin Pump Complexity
Diabetics who need insulin pumps are generally more complicated patients who require a higher level of service and adequate diagnosis coding to make the situation clear to payers. Usually, eligible patients "have already tried an aggressive regimen of shots, either three or four shots a day, and they're not getting their blood sugars controlled on that," says Anthony Azzi, MD, an endocrinologist with Raleigh Endocrine Associates in Raleigh, N.C.

The new codes "are going to help paint a better picture" of these complicated patients, says Elaine Rehmer, an administrator at the Cosmopolitan Diabetes Center in Columbia, Mo., which has a large insulin pump clinic practice. The codes will help justify the higher level of E/M service codes billed, which in turn will improve reimbursement and reduce denials, Rehmer says.

Remember: No matter which insulin pump V code you use, always report the diabetes diagnosis code 250.xx as well. Make sure you apply the fourth and fifth digits whenever possible. See page 3 for a refresher on how to choose the right diabetes code.
Know Your V Code Distinctions
You should use each of the three insulin pump V codes during different stages of the patient's treatment process (education/training, fitting/adjustment, and follow-up care). Use the following expert guidelines to ensure proper usage of these three codes:

1. Use V65.46 (Encounter for insulin pump training) when a patient is first considering an insulin pump. During this preliminary period, perhaps spanning one or two visits, we're doing more education than anything else, Rehmer says. 

The patient watches educational videos, receives basic training on how to use the pump, and gets to try actual pumps to see which models are most comfortable. Insulin pumps are fabulous, "But they do take a little bit of technical knowledge, and you do have to have a very good understanding of carb counting, how your pump works," when you need to adjust glucose levels, etc., Rehmer says.

For example, an established patient with insulin dependent, uncontrolled Type I diabetes (250.03) considers an insulin pump and comes in for a preliminary education and training session. If a nurse is doing the training, you report 99211 (Office or other outpatient visit for [...]

- Published on 2004-02-10