Ob-Gyn Coding Alert

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 to reproduction and development (V20V28). These codes will be used to more fully explain states of development and non-disease related issues. To report a normal pregnancy, you would use V22.X and, if there are historical risks, you would use V23.X. V codes are also used for contraceptives, sterilization and family planning (V25.X).

If the purpose of a visit is for screening for a specific disease, use the screening codes V72-V82. Some common ob/gyn screening V codes are:

V72.3-Gynecological examination with pelvic exam and pap smear (this excludes the pap smear without the general gyn exam which is V76.2).

V72.4-Pregnancy examination or test with pregnancy unconfirmed (excludes pregnancy examination and immediate confirmation V22.0-V22.1).

V76-Special screening for malignant neoplasms
V76.1 Breast
V76.2 Cervix (as part of a general gynecological examination)

Tip: As reported in the June 1998 issue of OCA (pages 22-23), Medicare only accepts the V76.2 code for a routine Pap smear every three years for women without high risks. For women with specifically defined risks, use V15.89.

2. For specific treatment of a disease or injury. In addition to their use with healthy patients, V-codes are also used when the patient has a disease or injury, but
the visit is only for a specific treatment or for specific aftercare.

For ob/gyns, this may be when a patient with a disease or injury visits the office simply for the insertion of a urinary catheter (V53.6). In this situation, no other service is provided.

3. Factors influencing health status. When a circumstance presents that influences, or could potentially influence, the patients health status, and she seeks contact with health services, a V code is also used. For example, if a woman learns that she has had contact with a known carrier of a venereal disease and wishes to be tested but has no symptoms or problems herself, you would use a V code (V01.6) as a primary diagnosis code.

4. When a problem or circumstance is not the prime, current purpose of the encounter. If the problem or circumstances influences the persons health status and more fully explains the current situation, the v codes are used. Some examples within the ob/gyn setting would be when the patient has a personal history of a malignant breast neoplasm (V10.4) or a family history of a malignant breast neoplasm (V16.3). In this circumstance, the V code would be used as a supplemental code to another or other diagnosis codes (001-999).

Diagnosis Wording May Indicate V Codes Often, there are key words or phrases in the diagnosis statement that signal the use of a V-code. Some of these phrases are: status post, screening for , aftercare, follow up removal of, history of, checking, examination, observation for, problem with, and chemotherapy.

Special Situations Generally, V codes for family history (V16-V19), follow up (V67.X), and post surgery do not stand alone to substantiate payment and should be sequenced along with other diagnosis codes (001-999). When a patient is seen for a personal history of cancer but now has no symptoms, the appropriate personal history V code (V10-V18) is the right code to use. The patient no longer has the cancer. The aftercare V codes (V51-V58) may be linked with services provided after a surgery. But these services are usually included in the surgical package and therefore not needed. When used in combination with other, non-V codes such as symptom codes, the V codes would appear last on the claim.