Anesthesia Coding Alert

Here's how to reduce denials -- and also increase your pay

Patients often request anesthesia anytime they anticipate pain during a procedure, but that doesn't mean the insurance carrier will pay for it. You can help justify anesthesia for some patients -- regardless of which procedure the surgeon performs -- by reporting the appropriate "V" codes.

Give the Full Picture With V Codes

The facts: The ICD-9 manual lists V codes under the category heading "Supplementary Classification of Factors Influencing Health Status and Contact with Health Services." This means that V codes often describe chronic conditions or underlying circumstances that might affect a patient's current health status or treatment.

How does this help you? Sometimes the V code will provide just enough information to turn a denial into appropriate -- or even extra -- reimbursement.

Your patient might have an underlying condition that upgrades him to general anesthesia instead of IV sedation or a local anesthetic, says Terry Garcia of Tejas Anesthesia in San Antonio. She sees this with patients whose conditions influence their health status (categories V40-V49). These V codes can help justify reporting a higher physical status modifier (P1-P6) for the patient and medical necessity for anesthesia -- both of which may lead to higher reimbursement.

Don't miss: In some cases, carriers require specific V codes before reimbursing you. For example, a New York policy lists only two diagnoses justifying post-operative epidurals: 958.8 (Other early complications of trauma) for patients being treated for major trauma but  not requiring surgery, and V58.49 (Other specified aftercare following surgery) for patients being treated for postoperative pain management.

Consider Reporting a V Code as Primary Diagnosis

Most coders relegate V codes to secondary diagnoses, but you can sometimes report a V code as your primary diagnosis. If ICD-9 designates a code as "SDx," you must report it as a secondary diagnosis. But if ICD-9 prints the symbol "PDx" next to a code, you can use it as your primary diagnosis. You can report codes without a designation as primary or secondary.

Example: "We've used the V10.x codes (Personal history of malignant neoplasm) as a primary diagnosis when coding for tests such as a colonoscopy or endoscopy," says Donna Howe, CPC, office manager of Anesthesia Associates of Eastern Connecticut in Manchester. She also recommends codes in the V16.x list (Family history of malignant neoplasm) if the patient has a family history and the referring physician wants to conduct regular testing as a preventive measure.

Other V codes that Howe and Garcia often use for primary diagnoses include V54.01 (Encounter for removal of internal fixation device) for orthopedic hardware removal, V59.4 (Donors; kidney) for donor nephrectomies, and V59.9 (Donors; unspecified organ or tissue) for organ harvesting. Code V64.1 (Surgical or other procedure not carried out because of contraindication) applies when physicians discontinue procedures after anesthesia induction.

Tip: Even if the V code applies as a primary diagnosis, it rarely stands alone (except in rare cases such as the New York epidural justification noted above). That's where secondary or supporting diagnoses come into play.

"Some V codes are clearly indicated as primary or secondary diagnoses," Howe says. "But when a circumstance influences a patient's health status but is not in itself a current illness or injury, the V code should only be used as a supplemental code." This can include medical histories of cancer, myocardial infarction, coronary artery bypass graft and other conditions.

"Many V codes are secondary codes and are only used for more information," says Samantha Mullins, CPC, an anesthesia coder with the physician group VitalMed Inc., in Birmingham, Ala. "This may be where some providers are not getting paid for the service, as they are placing their codes in the wrong order."

Make a List of Your Common V Codes

Using ICD-9 can be challenging, with its seemingly backward format (Volume II before Volume I). Remember these tips when you're seeking the best diagnosis code:

Tip 1: Volume I is the tabular index, and Volume II is the alphabetical index. Howe recommends always consulting Volume II first.

Tip 2: Review all of the V codes, noting the ones you use most often. Some coders make a separate list of these codes so they don't need to repeatedly search for them. Many V codes don't pertain to anesthesia, so Howe says to learn which ones do, so you can code appropriately.

Tip 3: Many entries in Volume II include keywords that help lead you to appropriate V codes (such as the codes associated with device removal). Watch for words such as "history," "admission," "aftercare," "encounter," "status" and "examination" to narrow down the appropriate choices.

Tip 4: Report V codes when other diseases or illnesses do not exist, Mullins says (such as for cured or healed conditions or for aftercare situations). But if another illness exists, report the appropriate code related to it. For example, if the physician removes a device because it caused an infection, report the complication code (probably from the 996.6 family, codes related to Infection and inflammatory reaction due to internal prosthetic device, implant, and graft) rather than a V code, Mullins says.

Remember: "The key to using V codes is knowing when an illness exists and when the service is just the follow-up, staged removal of a device or aftercare for a previous problem," Mullins says. "You only code the patient's current diagnosis or the reason for the medical care -- and sometimes that means using a V code."