Internal Medicine Coding Alert

New V codes provide coders with greater levels of specificity.

The new codes for ICD-9 2010 will soon take effect. And, while not all changes will affect your internal medicine practice, there are some revisions that you should check out, primarily in the area of V codes.

In total, there are 32 new V codes that appear in ICD-9 2010. These new codes cover several areas, including personal history of disease and health supervision of newborns. Here are some highlights:

You'll soon have a way to capture a laboratory examination that your internist orders as part of a routine general medical examination (V72.62). Currently there is no way to identify encounters for laboratory tests as part of general physical exams or for preparation for a procedure or treatment " says Jill M. Young CPC CEDC CIMC consultant with Young Medical Consulting LLC in East Lansing Mich. and American Academy of Professional Coders Chapters Association Vice Chair.

The skinny: ICD-9 2010 creates five V72.6x (Special investigations and  examinations) codes. These hints help you use these other new fifth-digit codes:For a laboratory examination that occurs at a different facility use V72.60 (Laboratory examination unspecified). You don't necessarily have to add V72.60 onto V70.0 (Routine general medical examination at a health care facility). When a patient has to have lab tests done at a diagnostic lab rather than in your office V72.60 will help indicate that the testing and exam (V70.0) occurred at different locations.

To allow for identification of a test ordered to pre-screen patients for potential health risks associated with a test ICD-9 creates V72.63 (Pre-procedural laboratory examination) Young explains. For example the dye in CT scans can cause problems with the kidneys. Through a screening blood test individuals who may be at risk from the dye can be identified before the test is performed. Use V72.61 for an antibody response exam. V72.69 was created to define "other laboratory exam."

If a patient is having ill effects due to a family member who is abusing substances ICD-9 2010 lets you indicate that situation with a specific V code: V61.42 (Substance abuse in family).

The use of illegal drugs or drug abuse by a family member can have an adverse effect on other members of the household Young says.

You previously had to lump a substance abuse in family health problem as another health problem using V61.49 (Health problems within family; other). The specific substance abuse code will allow better tracking of these specific circumstances.

Example: Jane is losing weight and has insomnia. Jane is dealing with her son who is an adopted drug addict or alcoholic or has been abusive to the parent. Jane's primary diagnosis could be the weight loss and insomnia but a contributing factor is the "problem child " so the V code can also be used along with the primary problem code such as the weight loss (783.21 Loss of weight) or insomnia (780.52 Insomnia unspecified).

Under the family disruption set (V61.0x) you'll also have two new codes:

• V61.07 -- Family disruption due to death of family member

• V61.08 -- Family disruption due to other extended absence of family member.

You can use these codes when a family member's death or absence affects a patient's health or is the reason for seeking or receiving medical advice or care according to ICD-9.

Young explains that the American Academy of Pediatrics (AAP) raised concerns that problems between adopted children and parents or foster children and parents should be better monitored. To this end they proposed revising V61.2 (Parent-child problems) and requested that a code for foster care status be created -- V61.25 (Counseling for parent [guardian]-foster child problem). Additionally V61.23 (Counseling for parentbiological child problem) and V61.24 (Counseling for parent-adopted child problem) were added to better clarify parent-child problems.

ICD-9 2010 expands the personal history of drug therapy V codes. "Coders now have a higher degree of specificity for medical necessity of visits diagnostic tests and procedures " notes Lynn Anderanin CPC CPC-I COSC senior coding consultant for Health Info Services in Park Ridge Ill.

Benefit: Providers can better justify the medical necessity for increased frequency of related screenings that payers often viewed as excessive Anderanin explains.

Example: When performing the lab test for total estrogen (82672) you currently use V87.49 (Personal history of other drug therapy). As of Oct.1 you can report V87.43 to specifically describe the personal history of estrogen therapy.

In addition V87.46 can be used to describe patients who have a history of receiving immunosuppressive therapy for conditions that compromise the immune system. These conditions could have been caused by some other kind of therapy or were the result of a disease. ICD-9 2009 currently has V87.41 V71.42 and V87.49.

Codes V87.43-V87.46 will be new ones for this subcategory.

They are defined as followed:

• V87.43 -- Personal history of estrogen therapy

• V87.44 -- Personal history of inhaled steroid therapy

• V87.45 -- Personal history of systemic steroid therapy

• V87.46 -- Personal history of immunosuppressive therapy.