Gastroenterology Coding Alert

Question: When a patient is seen for a follow-up from a liver transplant, I report V42.7 as the primary diagnosis. However, a co-worker pointed out that the ICD-9 manual uses blue squares to indicate secondary diagnoses, and V42.7 is listed with one. Which diagnosis code should I report?

Gastroenterology Discussion Group

Despite ICD's designation of V42.7 as a secondary diagnosis, you should report V42.7 (Organ or tissue replaced by transplant; liver) as the primary diagnosis. Because the patient was seen for follow-up of a transplant only without any symptoms, V42.7 accurately describes the reason for the visit. Many payers will reimburse for it.

If you receive a denial, you could report the reason for the liver transplant, such as liver cancer (e.g., 155.0, Malignant neoplasm of liver and intrahepatic bile ducts; liver, primary) or cirrhosis of the liver (e.g., 571.5, Cirrhosis of liver without mention of alcohol), as the primary diagnosis. You could then use V42.7 as the secondary diagnosis.