General Surgery Coding Alert

Question: I-ve heard again and again that I shouldn't use a V code as a primary diagnosis. But what if the surgeon changes/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: Thinking you can't use V codes as primary diagnoses is a popular misconception. In fact, there are a number of circumstances in which a V code is not only appropriate but necessary as a primary diagnosis.
 
When the surgeon attends to an artificial opening (an -ostomy-), such as in the case you describe, you may list a V code as primary. Eligible codes 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 ...).
 
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 if you may report a V code as a primary or secondary diagnosis code with the indicators -PDx- (primary) and -SDx- (secondary) next to the 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, according to ICD-9 instructions.
 
Another circumstance when you may report a V code as a primary diagnosis involves screening or prophylactic services. The most common example is perhaps for colon cancer screenings, in which case you should report V76.51 (Special screening for malignant neoplasms; colon) as the primary diagnosis.
 
Remember: V codes can also provide valuable information as secondary diagnoses (such as family history of disease -- for example, V10.3, Personal history of malignant neoplasm; breast).