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Internal Medicine Coding Alert

Reader Question:

Pre-Admit Tests

Published on Tue Jan 01, 2002

Question: Our internist is regularly asked to conduct ECGs for pre-admission testing. Which ICD-9 code, V72.83 or V72.81, should our practice report?

Connecticut Subscriber
  
Answer: Because V72.83 (other specified preoperative examination) is non-specific, the better choice is V72.81 (preoperative cardiovascular examination). ICD-9 coding guidelines require that practices use the most specific code available.
 
In addition, practices should assign a code for any underlying cardiac condition that might affect the outcome of the surgery and which probably prompted the preadmission testing. For example, if a surgeon is performing cataract surgery and is requesting a pre-admission or preoperative ECG because the patient has a known arrhythmia (427.9, cardiac dysrhythmia, unspecified) or other cardiac condition that may complicate surgery, these codes should follow the V code for the internists preoperative examination. The code explaining the reason for the surgery should come last (e.g., 366.22, total traumatic cataract).
 
However, many hospitals require all patients having surgery at their facility to undergo a pre-admission ECG and physical regardless of medical history. If this is the case, reimbursement becomes more complex. Correctly reporting the reason for the visit would require the coder to first assign the V code for the examination, followed by the ICD-9 code indicating the illness requiring the procedure. Some payers do not recognize V codes, or do not recognize them as a primary diagnosis code.
 
In addition, a diagnosis code for a cataract problem like the one in the example above is unlikely to appear on the 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, along with supporting documentation of the hospital requirement for the preoperative test. However, it is unlikely that the practice will be reimbursed for the preadmission test.

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