Ob-Gyn Coding Alert

Beware: Mislabeling a patient's history could have serious consequences If you-re shunning V codes because you think they-re only secondary diagnosis codes and don't pay well, you-re falling into the trap of some long-standing -- and highly inaccurate -- coding myths. The truth: 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. See if ignoring V codes is locking you out of carrier coffers. Myth #1: V Codes Are Secondary Diagnosis Codes "There are times when it's very appropriate to report V codes as a primary code," says Suzan Hvizdash, BSJ, CPC, physician education specialist for the University of Pennsylvania Pittsburgh's department of surgery. Example: A non-pregnant patient comes in for a hepatitis screening test. In the absence of any symptoms, you should report V73.89 (Special screening exam; other specified viral diseases). If the patient is pregnant, this is part of the antenatal screening. So you would use V28.8 (Other specified antenatal screening). V codes as primary diagnoses also come into play with Medicare's screening services. Many Medicare-covered screening tests require you to link the main procedure code to a V code. For example, for many average-risk patients, you-ll attach V76.2 (Special screening for malignant neoplasms; cervix: routine cervical Papanicolaou smear) to Q0091 (Screening Papanicolaou smear ...) to explain the reason for the collection, says Sean Weiss, CPC, CPC-P, CMPE, CCA-P, CCP-P, senior partner at The CMC Group LLC in Atlanta. (Note: Medicare covers screening Pap smears once every two years for its low- risk patients.) According to chapter 18 of the Medicare Claims Processing Manual, Medicare will also accept these diagnoses for low-risk Pap patients: - V72.31 -- Routine gynecological examination - V76.47 -- Special screening for malignant neoplasms; vagina - V76.49 -- - other sites. Note: The V code descriptor will indicate if you may report the code as a primary or secondary diagnosis code to Medicare with the indicators "PDx" (primary) and "SDx" (secondary). If the code has neither designation, you may use it as either a primary or secondary diagnosis code. Did you know? Ingenix, following outpatient coder editor (OCE) rules, put these indications in -- not ICD-9. Myth #2: V Codes Don't Pay Anything While it's true some V codes are only descriptors that give background information on the patient, the information they provide can help support the complexity or frequency of an E/M code that your office reports, says Jean Acevedo, LHRM, CPC, CHC, senior consultant with Acevedo Consulting Inc. in Delray Beach, Fla. They can also support the medical necessity of a claim, such as a chest x-ray or repeated lab tests. Example: You learned from "Clean [...]