Neurology & Pain Management Coding Alert

Question: We have disagreements in our office over whether negative jugular venous distention (JVD) falls under the cardiovascular or neck sections of an exam's documentation. Who's correct?

Answer: Both opinions could be correct, depending on the circumstances and the guidelines your office follows.

The 1995 guidelines allow body areas and organ systems. The physician checks jugular vein distention in the neck area, but he is looking for problems with the patient's cardiovascular system. If you follow the 1995 guidelines, you can't count the JVD exam toward both a body area and an organ system evaluation.

According to the 1997 cardiovascular and respiratory specialty examination guidelines, examination of the jugular veins is a "bullet" element in the neck body area. By that way of thinking, classify the JVD exam as part of the neck. The "Examination of jugular veins (e.g. distention; a, v or cannon a waves)" bullet is only listed in the cardiovascular and respiratory specialty exam guidelines and is not included in either the General Multi-system or other specialty exam requirements in the 1997 Medicare Guidelines.

Explanation: Providers often evaluate blood pressure in the jugular as a part of their physical exams of heart patients and use this information to make their diagnoses. When the blood pressure in the jugular vein is higher than normal, its walls can swell or distend, resulting in a condition known as jugular venous distension. Clinical evaluation of jugular veins in the neck gives the physician an estimation of the patient's central venous pressure. JVD can be an indication of right-side heart failure.