General Surgery Coding Alert

"Coding myth: V codes should never be used to report primary diagnoses.
 
Although it is inappropriate to use many of the V codes to report primary diagnoses, some V codes are the only choice for providing medical necessity for a procedure.
 
The introduction to the V Codes section of the ICD-9 manual states that they are used when:

 1. A person who is not currently sick encounters the health services for some specific purpose, such as to act as a donor of an organ or tissue, to receive prophylactic vaccination, or to discuss a problem which is in itself not a disease or injury.

 2. A person with a known disease or injury, whether it is current or resolving, encounters the health care system for a specific treatment of that disease or injury (e.g., dialysis for renal disease, chemotherapy for malignancy, cast change).

 3. Some circumstance or problem is present which influences the persons health status but is not in itself a current illness or injury.
           
 
Referring to the third set of circumstances for using V codes, the introduction states: In the latter circumstances the V code should be used only as a supplementary code and should not be the one selected for use in primary, single cause tabulations. Examples of these circumstances are a personal history of certain diseases, or a person with an artificial heart valve in situ. The wording of this passage may have helped perpetuate the myth that V codes should not be used to report primary diagnoses.
 
Note: In fact, personal history codes are among the V codes most frequently used appropriately as primary diagnoses, along with codes for artificial openings and prophylactic organ removal.

Personal History  
Personal history (and some family history) V codes are frequently required as primary diagnoses for high-risk screening colonoscopies, mammography, follow-up visits for cancer, and other services.
 
Medicare covers one screening colonoscopy every two years for beneficiaries at high risk for colorectal cancer. To qualify for these screenings, which are coded G0105 (Colorectal cancer screening; colonoscopy on individual at high risk), the patient must have at least one of three  conditions: (a) family history of colorectal cancer or adenomatous polyposis; (b) personal history of adenomatous polyps or colorectal cancer; or (c) inflammatory bowel disease (for example, Crohns disease or ulcerative colitis).
 
Personal and family history are indicated with one or more of the following V codes, reported as the primary diagnosis for the high-risk screening colonoscopy:

  V10.05 Personal history of malignant neoplasm; large intestine
  V12.72 Personal history of colonic polyps
  V16.0  Family history of malignant neoplasm; gastrointestinal tract
  V18.5  Family history of digestive disorders.  
As of July 2001, Medicare also pays for a low-risk screening colonoscopy once every 10 years. This service, which is coded G0121 (Colorectal [...]