Ob-Gyn Coding Alert

Coding Quiz:

Are You a Voracious V Coder?

Published on Thu Apr 28, 2005

Using a V code correctly can optimize your reimbursement

If you avoid V codes because they've got a reputation of being a series that doesn't bring reimbursement, you're making a mistake - many payers do reimburse procedures and services linked to these codes. After all, digging into the patient's past may reveal that V codes are often the right and ethical choice.

Read through the following questions and choose your answer from the V code word bank. Then turn to page 39 for the answers.

1. When you're doing a hepatitis screening test for a non-pregnant ob-gyn patient, you should report _______ in the absence of any symptoms.

2. A patient comes in for enteritis, but the ob-gyn doesn't order an NST - instead he documents that the patient's enteritis was not complicating the pregnancy. In that case, you should report 558.9 (Other and unspecified noninfectious gastroenteritis and colitis) and ______.

3. A surgeon was unable to complete a surgical procedure because the patient's sedation was ineffective and she resisted the insertion of a speculum. For the diagnosis, you should use 995.2 (Unspecified adverse effect of drug, medicinal and biological substance) plus _______ or _______.

4. If a pregnant patient has been exposed to Parvo but you don't have the definitive test results back yet, you should use 648.9x (Other current conditions classifiable elsewhere) plus ________ for the diagnoses codes.

5. For a patient who has had a tubal ligation but has not made an attempt to have it reversed, the only diagnosis would be _______.

6. When the ob-gyn doesn't get to the patient in time to deliver the baby (she delivers in the emergency department) but does deliver the placenta (59414, Delivery of placenta [separate procedure]), you should report ________ because the emergency-department doctor will report 650 (Normal delivery), assuming there are no other issues complicating the deliver.

CHOICES

V01.79 - Other viral diseases

V22.2 - Pregnant state, incidental

V24.0 - Postpartum care and examination; immediately after delivery

V26.51 - Tubal ligation status

V64.1 - Surgical or other procedure not carried out because of contraindication

V64.3 - Procedure not carried out for other reasons

V73.89 - Other specified viral diseases

1. ANSWER: V73.89. Because the question states "non-pregnant" patient, this is the V code you would use. However, if the patient is pregnant, you would use V28.8 (Other specified antenatal screening) because this is part of the antenatal screening, says Lana Flatt, CPC, a veteran coder for Ob Gyn Associates in Cookeville, Tenn.

2. ANSWER: V22.2. This code indicates "by the way, the patient is also pregnant," Flatt says. Keep in mind that if the enteritis is complicating the pregnancy, you should report 648.93 (Other current conditions classifiable elsewhere, but complicating pregnancy; antepartum condition or complication) along with 558.9. You wouldn't need a V code in this case.

3. ANSWER: V64.1 (Surgical or other procedure not carried out because of contraindication) or V64.3 (Procedure not carried out for other reasons). You may want to keep modifiers -53 (Discontinued procedure) or -52 (Reduced services) in mind for this case. For example, if the ob-gyn started the sedation and discontinues the procedure due to the patient's condition, you would use modifier -53. On the other hand, if the ob-gyn starts the procedure and the patient is not at risk, but the ob-gyn discontinues the procedure due to the physician's inability to complete the procedure, you would use modifier -52, Flatt says.

4. ANSWER: V01.79. This is because the ob-gyn only suspects the Parvo. If the ob-gyn confirms the Parvo, your diagnosis would change to 647.63 (Other viral diseases in the mother classifiable elsewhere, but complicating pregnancy; antepartum condition or complication). If the patient is not pregnant and the ob-gyn has not yet confirmed the Parvo, you would use only V01.79, Flatt says.

5. ANSWER: V26.51. You can find this diagnosis code under procreative management in the V26.x category. V26.51 reflects the reason this patient is sterile. Notice it excludes infertility not due to previous tubal ligation, which would direct you to the 628.0-628.9 diagnoses codes, says Becky Swank, CPC, coding analyst with the Wichita Clinic in Wichita, Kansas.

6. ANSWER: V24.0. Keep in mind if the ob-gyn provides antepartum care for this patient, you can report for the antepartum visits according to the number of visits, Swank says.