Internal Medicine Coding Alert

Question: When billing ECGs for pre-admission testing, should you use ICD-9 code V72.83 or V72.81? The patient is having cataract surgery.

Associates in Primary Care, Milburn, N.J.

Answer: According to the 1999 edition of ICD-9-CM, the code V72.83 (other specified preoperative examination) is non-specific and should not be used if another, more specific, code is available. You should use V72.81 (preoperative cardiovascular examination). If applicable, also code for any underlying cardiac condition. For example, if the surgeon performing the operation is requesting a pre-admission or preoperative ECG because the patient has a known arrhythmia or other cardiac condition that may complicate surgery, that should be coded following the V code for the preoperative examination. The code for the surgery should come last.

However, many hospitals require all patients undergoing surgery at their facility to undergo a preadmission ECG and physical regardless of medical history. If that is the case, it may complicate your reimbursement process. Correctly reporting the reason for the visit would require the coder to first assign the V code for the examination, V72.81 (preoperative cardiovascular examination), followed by the ICD-9 code indicating the illness requiring the procedure (e.g., 366.22, total traumatic cataract). Some payers do not recognize V codes, or do not recognize them as a primary diagnosis code. And, a diagnosis code for a cataract problem would not be on their list of covered diagnoses for the performance of an ECG.

In that situation, it is advisable to submit the claim with the appropriate V code as the primary diagnosis and the surgical ICD-9 code as a secondary diagnosis. Also submit supporting documentation of the hospital requirement for the preoperative test. If you are aware that a particular payer has a policy requiring the surgical diagnosis to be reported as primary, with the V codes for preoperative exams reported secondary, it would be appropriate to report that way.