Medicare Carriers Instructed To Accept V Codes for Pre-Op Consults
Published on Sun Jul 01, 2001
The Centers for Medicare & Medicaid Services (CMS, formerly HCFA) has instructed all local Medicare carriers to accept V codes for preoperative clearance. Until now, many carriers have routinely denied preoperative consults by cardiologists and other specialists if preoperative clearance V codes were used.
The announcement singles out four preoperative clearance ICD-9 codes, including:
V72.81 -- preoperative cardiovascular examination
V72.82 -- ... respiratory examination
V72.83 -- other specified preoperative examination
V72.84 -- preoperative examination, unspecified
The clarification, which revises section 15047 of the Medicare Carriers Manual (MCM), states that V72.81-V72.84 should be used to show medical necessity for preoperative clearance evaluations.
Medicare transmittal R1707-B3, issued May 31, instructs carriers to "delete any processing edits that deny claims or identify for manual review ICD codes V72.81 through V72.84." However, "claims containing these codes are subject to medical necessity determinations as described in MCM section 15047H."
According to the new language in section 15047C, Medicare will pay for all medically necessary preoperative clearances, such as those that involve "evaluating a patient's risk of perioperative complications and to optimize perioperative care."
Local Medicare carriers retain the discretion to determine the medical necessity for a preoperative clearance, CMS says.
"Medicare probably issued this to set the carriers straight," says Susan Callaway, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C. "Many carriers routinely denied these services on first submission when the V codes were correctly used as a primary diagnosis."
After the denial was appealed and the claim was reviewed manually, it was usually paid, Callaway says. But, she notes, not all such denials are appealed. The new revision should result in far fewer denials when cardiologists use a V code as the primary diagnosis.
According to the revised language in section 15047G, "All claims for preoperative medical examination and preoperative diagnostic tests (i.e., preoperative medical evaluations) must be accompanied by the appropriate ICD-9 code for preoperative examination (e.g., V72.81 through V72.84). Additionally, the appropriate ICD-9 code for the condition(s) that prompted surgery must also be documented on the claim. Other diagnoses and conditions affecting the patient [presumably, the condition that prompted the surgeon to send the patient to the cardiologist for a preoperative clearance] should also be documented on the claim, if appropriate."
The transmittal further specifies, "The ICD-9 code that appears in the line item of a preoperative examination or diagnostic test must be the code for the appropriate preoperative examination (i.e., V72.81 through V72.84)."
The clarification also means that cardiology coders can use the appropriate ICD-9 code to get paid for preoperative consults, Callaway says. She notes that in states where local Medicare carriers routinely deny consult claims with preoperative clearance V codes as the primary diagnosis, some cardiologists would use the condition (coronary artery disease or tachycardia, for [...]
