Anesthesia Coding Alert

Many coders hesitate to report V codes, or simply use them incorrectly, but sometimes this section of ICD-9 most accurately describes the reason for the patient's condition. In fact, V codes are often essential to reporting an anesthesia patient's medical history.

If you're not clear on the importance of V codes, check out these expert-approved answers to some often-asked questions:

To determine if you should use a V code, look for documentation in your anesthesiologist's report that will support physical status modifiers or use of Monitored Anesthesia Care (MAC), says Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla.

Knowing that a patient has a history of certain problems (such as a history of sudden cardiac arrest) could affect how your provider delivers anesthesia or monitors the patient. The personal history might also help justify having anesthesia services available (either already providing service or with the anesthesiologist on stand-by) for procedures that might not normally need anesthesia.

Important: V codes are not only appropriate as secondary codes. You may occasionally encounter a situation where a V code is necessary as the primary diagnosis. In some cases, reporting a V code might be the only way you'll be paid for a service.

"If there are chronic conditions that affect the physical status, such as diabetes, lung disease, or cardiovascular disease, then these should be coded in addition" to the current diagnosis codes, says Julee Shiley, CPC, CCS-P, ACS-AN, a coding professional in North Carolina.

Example: A gastroenterologist requests your anesthesiologist at a colonoscopy because the patient has been resistant to moderate sedation in the past. Using V15.80 (History of failed moderate sedation) could justify why the anesthesiologist was at the colonoscopy.

"Coders that are not aware of the ICD-9 history codes often err and report the ICD-9 code(s) indicating that the patient has the active or ongoing condition, rather than reporting the compliant and associated patient history code," Dennis says.

If you find it tricky to distinguish primary from secondary V codes, ICD-9 gives you some helpful hints. Many versions of the ICD-9 manual use a symbol, such as a "1" or a "2" inside a circle, to indicate in what order you should report the code (such as "first listed or primary Dx," "first listed or additional," or "additional or secondary Dx only"). You'll find these indicators next to the code descriptor.

Example: An anesthesiologist provides MAC to a patient with a history of transient ischemic attack (TIA), an episode in which a person has stroke-like symptoms for less than 24 hours. According to ICD-9, you may report V12.54 (Stroke [cerebrovascular]) as the primary diagnosis and the reason for the surgery as the secondary diagnosis.

Use of V codes for anesthesia can be very different from other specialties' use of the codes. "There are some unique circumstances, such as anxiety and/or conditions involving spasticity or dementia, that require anesthesia for procedures that would not normally require involvement of anesthesia," Shiley says. Some examples would be for diagnostic services such as MRI and CT scans, she says.

You may also use V codes to provide additional clinical information to an insurer, whether you're dealing with Medicare or a private payer.

Warning: Payer policies on use and payment of V codes are constantly shifting. Always check with your payer to confirm their policy on V codes.

Final reminder: Only report a diagnosis supported by documentation and avoid reporting history codes with a current illness diagnosis. You should never assign an ICD-9 code merely for the purpose of achieving payment by falsely claiming medical necessity. This is fraudulent, which can result in serious financial and criminal consequences, and can harm patient outcomes.