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.
 
Caution: -I really believe reporting V codes is underutilized, especially in the outpatient setting,- says Mary Mulholland, BSN, RN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvania's department of medicine in Philadelphia.

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.

Read 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, but the ob-gyn doesn't order an NST--instead he 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 648.9x (Other current conditions classifiable elsewhere) 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 _______.

Next, compare your responses to these expert answers.

Check Out These V Basics
 
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. If the code has neither a -PDx- nor an -SDx- designation, you may use that V code as either a primary or secondary diagnosis code, according to ICD-9 instructions.

Note: Payers may be more likely to deny claims that list a V code as the primary diagnosis on the claim, says Michael A. Granovsky, MD, CPC, FACEP, vice president of MRSI, a coding and billing company in Stoneham, Mass.

But you can't choose your codes based on payment. You should follow the official coding guidance available at www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide06.pdf.

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. ICD-9 classifies V codes into four general categories:

- When a person who is not sick encounters the health services for some specific purpose, such as to act as the donor of an organ or tissue, to receive a prophylactic vaccination, to discuss a disease or injury, or to undergo a screening exam.

- When a person with a known disease or injury, whether it is current or resolving, encounters the healthcare system for a specific treatment of that disease or injury (for instance, dialysis for renal disease, chemotherapy for malignancy, cast change).

- When a circumstance or problem influences the patient's health but is not itself a current illness or injury.

- Newborns, to indicate birth status.

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.

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 V28.8 (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.

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. You wouldn't need a V code in this case.

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.

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.