Ob-Gyn Coding Alert

Get ready for 20 new V codes you need to know

If you forgo learning new codes for urinary symptoms, diagnostic testing, pain and other symptoms, you-re not getting the full ICD-9 2007 picture. Make sure you-ve got these categories covered by the Oct. 1 deadline.

Add Options to Your Urinary Symptom Arsenal

New options: The next round of updated ICD-9 codes will offer two new urinary symptom codes: 788.64 (Urinary hesitancy) and 788.65 (Straining on urination). 

Old way: You-ll benefit from the addition of 788.64 and 788.65, two conditions that were previously not listed, says Susan Vogelberger, CPC, CPC-H, CMBS, owner and president of Healthcare Consulting & Coding Education LLC in Boardman, Ohio. You-ve been forced to report these symptoms with 788.9 (Other symptoms involving urinary system), but staring in October you-ll have more specific options.

Example: Your ob-gyn sees a patient for an established E/M visit and evaluates her for possible outflow obstruction. All you have to report are the symptoms until the testing is complete. In this case, you can use 788.64 and 788.65.

Claim Victory Over These V Code Additions

You-ve got a slew of new V codes to report starting Oct. 1.

ICD-9 2007 has added V codes to more thoroughly complete your diagnosis picture: V86.0 (Estrogen receptor positive status [ER+]) and V86.1 (Estrogen receptor negative status [ER-]). Estrogen is involved in the development of breast cancer, and estrogen receptor status determines the sensitivity of lesions to tamoxifen and aromatase inhibitors. You should use these codes as your secondary diagnosis.

Example: A patient has postmenopausal estrogen-receptor estrogen-dependent breast cancer. To report this condition, you should report the breast cancer as the primary code (such as 174.x, Malignant neoplasm of female breast [primary]) and V86.0 as your secondary code.

Second, you have two new family history codes--V18.59 (Family history, other digestive disorders) and V18.51 (Family history, colonic polyps). Once V18.51 becomes effective, you-ll be able to use this more specific code instead of V18.5 (Family history; digestive disorders).

You-ll also need to know 20 new V codes that include:

- a change or removal of wound dressings or sutures (V58.30-V58.32) rather than V58.3 (Attention to surgical dressings and sutures)

- pediatric body mass index (V85.51-V85.54) for ages 2-20

- genetic screening codes that include V26.34 (Testing of male for genetic disease carrier status), V26.35 (Encounter for testing of male partner of habitual aborter), V26.39 (Other genetic testing of male), V82.71 (Screening for genetic disease carrier status) and V82.79 (Other genetic screening).

Also, ICD-9 revised these V codes: V26.31 (Testing of female for genetic disease carrier status) and V26.32 (Other genetic testing of female).

Test Your Knowledge of These Testing Codes

When you-re dealing with diagnostic tests, you have a few new 2007 ICD-9 codes to use.

You-ll have new options for reporting test results, including 795.06 (Papanicolaou smear of cervix with cytologic evidence of malignancy), 795.81 (Elevated carcinoembryonic antigen [CEA]), 795.82 (Elevated cancer antigen 125 [CA 125]) and 795.89 (Other abnormal tumor markers).

Example: Your ob-gyn performs a Pap test and has the patient return to discuss the abnormal finding and to recommend further testing and treatment. You should report an E/M service for this visit along with 795.06 as your diagnosis.

Also look for two new radiological codes this October: 793.91 (Image test inconclusive due to excess body fat) and 793.99 (Other nonspecific abnormal findings on radiological and other examinations of body structure). These codes replace the deleted 793.9 (Other nonspecific abnormal findings on radiological and other examination of body structures).

Example: Your ob-gyn performs an ultrasound for a pelvic mass, but due to the patient's obesity, he cannot determine if it is a fibroid tumor or ovarian cancer. He may recommend exploratory surgery to make a definitive diagnosis, and using 793.91 will give the payer more information about medical necessity.

Coding for Pain Will No Longer Be a Pain

Next year's ICD-9 codes include a new section (338) for different types of pain, including central pain syndrome, and acute and chronic pain due to trauma, thoracotomy or postoperative pain.

Benefit: The ability to code for acute or chronic postoperative pain will be useful for several different purposes, says Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc. in Powder Springs, Ga.

For example, you can use these codes to justify a pain management visit (99201-99215) or the insertion of the On-Q device that administers postoperative anesthetic to the operative site, admitting a patient postoperatively (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient -), or prolonging the patient's hospital stay (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient -).

Another option: If you-ve ever wondered which pain code you should report when the ob-gyn documents -generalized pain,- you now have an answer--780.96--although some coders believe that ob-gyns normally see more precisely defined pain syndromes.

Add More-Specific Symptom Codes

The march toward specificity continues with more options that get you out of the taboo -other- or -other specified- zone. Look out for these opportunities to better describe a patient's symptom.

Example: A patient has a postnasal drip, but the physician doesn't diagnose the patient with allergies. You now end up with a potentially problematic -other- code (784.9, Other symptoms involving head and neck). ICD-9 2007, however, will allow you to pinpoint the symptom with specific code 784.91 (Postnasal drip).