Ob-Gyn Coding Alert

Learn when you can use V codes as primary diagnoses

The V codes are not only for providing supplemental information on your ob-gyn claims, and you could be facing denials or lower payments because you're avoiding V codes. They are, in fact, key elements to correct coding practices.

You don't have to be wary of using your V codes. Take this quiz and see how you score when it comes to V codes.

Challenge Yourself to These 7 Questions

Question 1: True or False: You can use V codes as primary diagnosis codes.

Question 2: True or False: You should use V codes only to represent "history of" diagnoses.

Question 3: 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 delivery.

Question 4: When you're doing a hepatitis screening test for a non-pregnant ob-gyn patient, you should report _______ in the absence of any symptoms.

Question 5: A patient comes in for enteritis, and the ob-gyn 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 ______.

Question 6: If a pregnant patient has been exposed to Parvo but you don't have the definitive test results back yet, you should use V23.89 (Other high risk pregnancy) and ________ for the diagnoses codes.

Question 7: For a patient who has had a tubal ligation but has not made an attempt to have it reversed, the only diagnosis would be _______.

Check Out These V Basics

Have your solutions? Check them against our answers.

Answer 1: True. If you're surprised, take heart. Many coders mistakenly believe that V codes are only appropriate as secondary codes.

Reality: Contrary to what you might have been told in the past, you may--and, on occasion, should--report V codes as a primary diagnosis.

Tip: Certain versions of the ICD-9 manual indicate whether 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.

"The ICD-9-CM Coordination and Maintenance Committee decided that this designation was confusing, especially for the outpatient setting, and discontinued its use a few years ago," states Melanie Witt, RN, COBGC, MA, an independent coding consultant in Guadalupita, N.M. "If your ICD-9 version includes this information, use this information only as a general guide." If the code you intend to use represents the only reason for visit, you may use it as the primary diagnosis code if it meets one of the 3 basic V code guidelines in the outpatient setting:

• 1) The patient is not currently sick but encounters the health services for some specific purpose (for instance, placement of an IUD or presenting for contraceptive or procreative counseling)
• 2) The patient has a known disease or injury, but is having a specific treatment for it in the office setting which is described by a V code (such as receiving chemotherapy)
• 3) The patient has some circumstance or problem present which influences her health status but is not in itself a current illness or injury (such as a history of malignancy).

Note: Payers may be more likely to deny claims that list a V code as the primary diagnosis on the claim, experts say.

But you can't choose your codes based on payment. You should follow the official coding guidance available at http://www.cdc.gov/nchs/data/icd9/icdguide10.pdf. Check chapter 18 for information about V codes.

Answer 2: False. 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.

Apply Actual Diagnosis Codes

Answer 3: V24.0 (Postpartum care and examination; immediately after delivery). Keep in mind that if the ob-gyn provides antepartum care for this patient, you can also report the antepartum visits according to the number of visits.

ICD-10: When your coding system changes in 2013, V24.0 will become Z39.0 (Encounter for care and examination of mother immediately after delivery).

Answer 4: V73.89 (Special screening exam; other specified viral diseases). Because the question states "non-pregnant" patient, this is the V code you would use. However, if the patient is pregnant, you would use V28.89 (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.

ICD-10: Code V73.89 will become Z11.59 (Encounter for screening for other viral diseases), and V28.89 will become Z36 (Encounter for antenatal screening of mother).

Answer 5: V22.2 (Pregnant state, incidental). This code indicates "by the way, the patient is also pregnant," Flatt says. 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 (Other and unspecified noninfectious gastroenteritis and colitis). You wouldn't need a V code in this case.

ICD-10: Code V22.2 will become Z33.1 (Pregnancy state, incidental).

Caution: You cannot use a translation table to find the replacement code for the many conditions that would be applicable under ICD9 code 648.93. Instead, you would have to know that the ICD9 code for enteritis (558.9) will become either K52.89 (Other specified noninfective gastroenteritis or colitis) or K52.9 (Noninfective gastroenteritis and colitis, unspecified). And you would have to also know that this code category indicates a digestive problem. This leads you to look in the alphabetic index under Pregnancy, complicated by, digestive system disorder (condition in K00-K93) O99.61-. So your correct codes would be:

• O99.611, Diseases of the digestive system complicating pregnancy, first trimester
• O99.612, Diseases of the digestive system complicating pregnancy, second trimester
• O99.613, Diseases of the digestive system complicating pregnancy, third trimester
• O99.619, Diseases of the digestive system complicating pregnancy, unspecified trimester

Answer 6: V01.79 (Contact with or exposure to other viral diseases). 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.

ICD-10: Code V01.79 will become Z20.828 (Contact with and [suspected] exposure to other viral communicable diseases).

Code 647.63 will become three codes which specify trimester: O09.511 (Other viral diseases complicated pregnancy, first trimester), O98.512 (... second trimester), O98.513 (... third trimester).

Answer 7: V26.51 (Tubal ligation status). You can find this diagnosis code under procreative management in the V26.x category. Code V26.51 reflects the reason this patient is sterile. It excludes infertility not due to previous tubal ligation, which would direct you to the 628.0-628.9 diagnoses codes.

ICD-10: Code V26.51 will become Z98.51 (Tubal ligation status) in 2013.