Ensure Accurate Claims for Well Visits and Diagnostic Services with Correct Use of V Codes
Published on Sat Aug 01, 1998
Many coders fear the use of V codes, says Liza Green, RRA, CCS-P, revenue coordinator for ob/gyn at Mayo Clinic in Scottsdale, AZ, because many payers do not recognize them. In some practices, this fear has led coders to abandon the use of V codes altogether. However, Green points out, reimbursement issues aside, the V code is often the right code to use when the patient presents without symptoms that would indicate a diagnosis of disease.
All diagnosis codes are used to explain the purpose of an encounter with health services. The first part of the tabular list in the ICD-9-CM book (codes 001-999) covers diseases, injuries and signs and symptoms. The V and E codes make up the second part of the list and are used (often supplementally) to report circumstances other than the actual diseases, injuries or signs and symptoms. V codes deal with factors that influence the health of the patient and factors that explain the need for contact with health services. E codes deal with causes of injury and poisoning.
Correct coding and reimbursement do not always go together. Indeed, the correct code for an encounter may be a V code, but this does not necessarily mean it will be reimbursed. For example, if a woman is seen for surveillance of previously prescribed contraceptive methods, the correct code is V25.4, but most insurance companies do not cover this service. In an era of increased attention to fraud and abuse, its essential that coding represent the actual situation and not just what is best for reimbursement.
According to the ICD-9-CM guidelines there are three
specific circumstances in which V Codes should be used. We have added examples outlining how these codes could be used in an ob/gyn practice.
1. When a healthy patient needs health services. These situations may include: a patient who needs a preventive physical examination but has no symptoms or problems; a patient who needs to discuss a problem or concern that is not, in itself, a disease or injury; a patient who is to become an organ or tissue donor; or, a patient who is to receive a prophylactic vaccination.
In the ob/gyn setting, these circumstances can present when the provider sees a woman for a preventive well-woman exam (V72.3), or when he or she sees women who needs an examination for employment, the armed forces or a special institution (V70.5). A patient might also contact your office for paternity testing (V70.4) or for observation following sexual assault (V71.5). A patient visit may also be for family problems or unusual relationship circumstances (V61.X), or anyone seeking consultation without complaint or sickness (V65.X).
Some of the most common healthy patient V codes used in ob/gyn practice will be those related [...]
