ED Coding and Reimbursement Alert

Question: Please straighten something out for me. I have heard again and again that I should not use a V code as a primary diagnosis. But what if the emergency physician changes or replaces a gastrostomy tube? I can find no diagnosis other than V55.1 to support the service. Can I use the V code as primary in this case?

Utah Subscriber

Answer: Assuming you can't use a V code as a primary diagnosis is a popular misconception. In fact, there are a number of circumstances in which it is not only appropriate but also necessary to report a V code as a primary diagnosis.

According to the ICD-9 coding guidelines, aftercare codes are generally first listed to explain the specific reason for the encounter.

When the physician attends to an artificial opening (an -ostomy-), such as in the case you describe, you may list a V code as primary.

Eligible codes that can be considered as primary diagnoses include V55.0-V55.9 (and, specifically, V55.1, Attention to artificial openings; gastrostomy) and V58.81-V58.82 (Other specified procedures and aftercare; fitting and adjustment of catheter ...).

So if the ED physician replaces a patient's gastrostomy tube, you could report 43760 (Change of gastrostomy tube) with V55.1 as the primary diagnosis.

Caution: You should not report ICD-9 V codes V44.0-V44.9 (Artificial opening status) as primary codes. These diagnoses only indicate that the patient has undergone an ostomy procedure, not that the surgeon has performed any particular service. You should report these codes as secondary only.

Tip: Many versions of the ICD-9 manual will indicate whether you may report a V code as a primary or secondary diagnosis code with the indicators -PDx- (primary) and -SDx- (secondary) next to the ICD-9 code descriptor.

If the code has neither a -PDx- nor an -SDx- designation, you may use that V code as either a primary or secondary diagnosis code based on CMS coding edits.

Remember: V codes can also provide valuable information when used as secondary diagnoses (such as V10.3, Personal history of malignant neoplasm; breast).