Neurosurgery Coding Alert

V codes can provide diagnostic info. for non-acute conditions

If your neurosurgery practice shuns V codes because you believe they provide only supplemental or incidental information, you'll want to reconsider. In fact, V codes can serve as the primary diagnosis when the surgeon provides screening services, and also provide important details for aftercare.

If a V Code Is the Best Option, Use It

Contrary to what you might have been told, you may - and, on occasion should - report V codes as primary diagnoses. "Practices can use V codes for primary diagnoses under certain circumstances," affirms Susan Vogelberger, CPC, business office coordinator for the Orthopedic Surgery Center at Beeghly Medical Park in Ohio.

Tip: Many versions of the ICD-9 manual will indicate if you may report a V code as a primary or secondary diagnosis code with the indicators "PDx" (primary) and "SDx" (secondary) next to the code descriptor. If the code has neither a "PDx" nor an "SDx" designation, you may use that V code as either a primary or secondary diagnosis code, according to ICD-9 instructions.

Perhaps the most common instance when you should select a V code as a primary diagnosis is for screening exams. These could include screenings for neoplasms (for instance, V76.81, Special screening, other neoplasm, nervous system), as well as other diseases (V80.0, Special screening; for neurological conditions).

Be aware: A "screening" means that the surgeon performs an exam to determine the presence of a condition in the absence of any relevant signs or symptoms.

For instance: If a patient presents with symptoms such as dizziness (780.4), headaches (784.0) and nausea (787.02), the surgeon might want to examine the patient for a neoplasm of the brain. In this case, you should use the signs and symptoms to justify the exam - not a screening code such as V76.81. Rather, you should use screening codes, including V76.81, for routine exams for pre-employment, insurance evaluations, etc.

After Care Provides More V Code Opportunities

You might also use V codes as a primary diagnosis when the surgeon provides follow-up care for a patient with past injuries and/or treatment.

Example: A patient suffers a traumatic spinal fracture due to a fall. "If a patient returns for follow-up care after a [spinal] fracture, you shouldn't report the fracture code again," Vogelberger notes.

In other words, if the spinal fracture is no longer an acute condition (that is, the fracture has healed following physician care), you are incorrect to use a fracture code as a primary diagnosis. Rather, you should turn to V54.17 (Aftercare for healing traumatic fracture of vertebrae).

Example 2: Coders and physicians often make the mistake of overlooking V codes for patients whose disease process is no longer active, notes Jean Acevedo, LHRM, CPC, CHC, senior consultant with Acevedo Consulting Incorporated in Delray Beach, Fla.

For instance, a female patient who has successfully undergone surgery for removal of a brain neoplasm visits the surgeon for evaluation of wound and neurological deficits.

In this case, rather than report an acute diagnosis of brain neoplasm (for instance, 191.1, Malignant neoplasm of brain, frontal lobe) - which is inaccurate - you should select V58.42 (Aftercare following surgery for neoplasm) to reflect that the check-up is for a condition that is no longer acute. "Aftercare visit codes cover situations where the initial treatment of a disease or injury has been performed and the patient requires continued care during the healing or recovery phase," according to ICD-9 guidelines.

What V Codes Can Do for You

V codes are your keys to documenting chronic conditions or underlying physical or social circumstances that can affect a patient's current health status or treatment. ICD-9 classifies V codes into three general categories, as follows: