Home Health ICD-9/ICD-10 Alert

Question: We are seeing preterm babies for Synagis injections. We had been using category 765 .x (Disorders relating to short gestation and low birthweight) to code the age of gestation, but now we are getting denied claims because these patients are 3 to 4 years old and those codes no longer apply.

What is the correct code to use to continue with the Synagis injections? Can we use the V58.69 code (Long term [current] use of other medications)?


Colorado Subscriber

Answer: Synagis is a monoclonal antibody. It is used to prevent viral respiratory tract infections (due to respiratory syncytial virus or RSV) in infants and young children at risk for infection. Synagis works by preventing the growth of RSV.

Ask the payor what codes they expect for such patients. Some codes you might consider are V04.82 (Need for prophylactic vaccination and inoculation against Respiratory syncytial virus [RSV]) and V07.2 (Prophylactic immunotherapy).

Code V58.69 is actually a status code indicating that the patient uses a high-risk drug, not that you are providing any care. This code is a secondary code only and not your best choice in this case because there are more specific codes you can use.