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You Be the Coder: Insulin Pump V Codes Correspond With 3 Stages

Question: Would you explain when to use each of the three insulin pump V codes? Do we have to report one of these codes when we're treating a patient who uses an insulin pump?

Minnesota Subscriber

Answer: You don't have to report a V code for insulin pump use, but using V codes does help paint a better picture of the complicated type I diabetic patients who require insulin pump therapy. The V codes can help justify a higher level of E/M service, which in turn will improve reimbursement and reduce denials.

Recognize Three Separate Stages: Each of the three insulin pump V codes corresponds with three different stages of the patient's treatment process: education/
training, fitting/adjustment, and follow-up care. Use these expert guidelines to ensure proper V code usage:

1. V65.46 (Encounter for insulin pump training). Use this code when a patient is first considering an insulin pump and comes in for initial education. Patients may watch educational videos, receive basic training on how to use the pump and examine different pump models to select the one that is most comfortable.

Often a nurse will take care of preliminary insulin pump education. In this case, you might report 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician) along with the appropriate diabetes code (250.xx) and V65.46.

2. V53.91 (Fitting and adjustment of insulin pump). Use this code when the patient first receives the insulin pump and deals with initial adjustment and fitting. A nurse or endocrinologist may perform these services, depending on the office. V53.91 is usually appropriate for the first two visits after a patient starts using the pump because the physician is making initial adjustments to the device.

3. V45.85 (Insulin pump status). Use this code for all other follow-up visits associated with the pump. Especially in the beginning, patients usually return to the office quite frequently to change settings and monitor progress. After the initial set-up stages, V45.85 is the code to use for all subsequent visits, including the eventual routine checkups.

Routine diabetes checkups: Although the endocrinologist will examine all the patient's diabetes-related health issues - not just the insulin pump status - during a routine diabetes checkup, you should include V45.85 as one of the diagnoses. This code will help describe the complications of the patient and justify your level of service.

Important: If the patient comes in for a special visit because the insulin pump causes a problem, you should report diagnosis code 996.57 (Complication due to insulin pump).

Remember: No matter which insulin pump V code you use, always report the diabetes diagnosis code 250.xx as the primary diagnosis and the V code as secondary.

- Published on 2004-11-21

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