Anesthesia Coding Alert

Don't shy from submitting the same V code as surgeons.

If you avoid the V code section of ICD-9 because you aren't sure whether the choices apply to anesthesia claims, it's time to take a closer look. V codes provide additional information and specificity, which can help get a claim paid.

Remember Both MDs Can Report V's

The surgeon and anesthesiologist can both submit the same V code for a patient's primary diagnosis or to help explain the patient's medical history.

Example: Your anesthesiologist might be involved with prophylactic removal of a patient's ovary. Both physicians could report V50.42 (Prophylactic organ removal; ovary). You could also include V16.41 (Family history of malignant neoplasm; ovary) if applicable.

"I usually suggest that coders report diagnoses related to anesthesia," says Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fl. "The exception is when an insurance company requests the V code, so you need to be familiar with the options."

Watch for Chart Clues

Anesthesia coders sometimes rely on V codes in different ways from other specialties. Information you find in the anesthesia provider's notes can point you to V codes that might go overlooked.

Example: ICD-9 expanded the body mass index (BMI) choices in 2011 to demonstrate higher BMIs with five new codes (V85.41-V85.45), says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC, with CRN Healthcare Solutions in Tinton Falls, N.J. Patients with a high BMI can cause additional work for an anesthesiologist during the procedure, so including BMI codes in your claim can help justify your provider's service.

Tip: Think ahead for potential V code usage, even during the pre-operative anesthesia assessment. "BMI has become an important health tool," says Susan Vogelberger, CPC, CPCH, CPC-I, CMBS, CCP-P, CEO of Healthcare Consulting & Coding Education LLC. "There are those who are of the opinion that BMI should be an eighth option when counting vital signs for the 'constitutional' bullet in the E/M physical exam, especially in bariatrics and orthopedics/sports medicine."

Double Check Guidelines

Payers can have different guidelines regarding their use or acceptance of V codes.

Example: Aetna policies allow V58.64 (Long term [current] use of non-steroidal anti-inflammatories [NSAID]) as a possible diagnosis supporting trigger point injections or radiofrequency facet denervation if certain criteria are met. Code V58.64 is not listed as a viable option, however, for back pain treatments such as percutaneous lumbar discectomy or facet joint injections.

Tip: Check your payer's policies before submitting claims with V codes. Experts also recommend that you periodically review the ICD-9-CM Official Guidelines for Coding and Reporting since it never hurts to remind yourself of coding basics.

"Many of the Medicare Administrative Contractors [MACs] offer free ICD-9 coding and refresher courses," says Dennis. "You can earn AAPC credits and learn more about how to report any of the ICD-9 codes correctly."