Ob-Gyn Coding Alert

HRT and organ absence top list of new ICD-9 V codes

ICD-9's new V codes, effective Oct. 1, will allow you to be more specific when denoting factors that influence health status and explaining contact with health services. The changes include the following:

Exposure to communicable diseases: The American Academy of Pediatrics requested code additions for exposure to viral and other communicable diseases. The most important for ob-gyns will be the code for exposure to chickenpox (Varicella) if the pregnant patient has not previously been exposed. This new code (V01.71) may be enough to support the medical necessity for laboratory work to test for chickenpox immunity. You will report V01.79 for exposure to other viral diseases.

Hormone replacement therapy: National Center for Health Statistics'ICD-9-CM Coordination and Maintenance Committee moved the term "postmenopausal" to the status of a parenthetical note for V07.4 (Hormone replacement therapy [postmenopausal]). In addition, ICD-9 clarifies that you should not use V58.69 (Long-term [current] use of other high-risk medications) if the patient is on hormone replacement therapy. Instead, you should submit V07.4.

Acquired absence of organ: The ICD-9 update clarifies that V45.77 (Acquired absence of genital organs) excludes the new codes for female genital mutilation status (629.20-629.23).

Long-term (current) drug use: ICD-9 will include two new codes for long-term use of aspirin (V58.66) and insulin (V58.67).

Lack of adequate sleep: You should report the new code V69.4 for sleep deprivation, but it excludes insomnia as a complaint.

Gynecologic exam: ICD-9 expands V72.3 (Gynecological examination) into two codes, as the American College of Obstetricians and Gynecologists requested. You should use the first code, v72.31 , for the routine gynecologic examination that either does or does not include a Pap smear. If the ob-gyn performs a vaginal Pap smear during the exam, you would submit V76.47 (Special screening for malignant neoplasms; vagina) in addition. You should use new code V72.32 to report the Pap smear the ob-gyn collects to confirm findings of a recent normal smear following an initial abnormal smear. In other words, the patient had an abnormal Pap smear, the physician brings her back three months later for another Pap (the diagnosis for this Pap will be the abnormal results from the first smear), and then a few weeks later the results come back as normal. She returns three months later after one normal Pap result, and you code V72.32 for this encounter.

Pregnancy exam or test: When the ob-gyn performs a pregnancy test prior to doing a procedure or because he suspects pregnancy, the ICD-9 revisions offer a solution. It expands V72.4 (Pregnancy examination or test, pregnancy unconfirmed) into two codes. You will use V72.40 when your physician performs a pregnancy test, but at the end of the visit has not confirmed whether she is pregnant (that is, he performs a blood test rather than a urine test). You should submit V72.41 if the doctor confirms she is not pregnant during this visit. If the pregnancy test is positive, you will use V22.x (Normal pregnancy) for the encounter per ICD-9 guidelines.

Screening for osteoporosis: ICD-9 clarifies that you will report V07.4 (Hormone replacement therapy [postmenopausal) with the osteoporosis screening code (V82.81), if applicable.

Genetic susceptibility to disease: ICMC adds a whole new category of codes to identify encounters for prophylactic organ removal. Some patients who have a genetic susceptibility to a malignancy may request an organ's removal to prevent the disease from occurring. Although ICD-9 already offers codes that indicate an encounter was for an organ removal, it did not include codes to indicate why, until now. And, ob-gyns needed these new codes because you can use the current "carrier status" codes only when a person is a disease carrier and is able to pass it on to offspring. Before you report these codes, the patient's record should include documentation of an abnormal gene confirmed by a genetic test. The new codes are: