Ob-Gyn Coding Alert

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.

"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.

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 Up Ob Confirmatory Visit Claims With 3 Q&As" that you can report a low-level E/M service if the ob-gyn discusses some aspect of a patient's health along with confirming a patient's pregnancy, prior to beginning an ob record. You-ll report the E/M code (99201-99202 for new patients, or 99211-99212 for established patients) and use V72.42 (Pregnancy confirmed) as the primary diagnosis.

History example: A 23-year-old female patient discovers a lump in her breast during her monthly at-home breast examination. The physician suspects the lump is a cyst, but the patient has a strong family history of aggressive malignant breast cancer, so the physician decides to perform a mammogram. Normally, mammography is not a covered service for such a young patient; however, by reporting V16.3 (Family history of malignant neoplasm; breast) to the carrier, the physician provides evidence of medical necessity to perform the mammogram.

The value of V codes is nothing new to Kathy Stuart, billing manager for Avalon Medical Group in Chapel Hill, N.C., who uses them regularly. She uses them for physicals, counseling and histories, she says. The codes she reports include:

- V68.0x -- Encounters for administrative purposes; issue of medical certificates

- V58.69 -- Long-term (current) use of other medications

- V65.5 -- Person with feared complaint in whom no diagnosis was made (also commonly referred to as the "hypochondriac code" by coders).

Pitfall: Acevedo often sees physicians failing to use V codes for patients whose disease process is no longer active. For example, a female patient whose previous CIN II (cervical intraepithelial neoplasia II) was successfully treated comes in for a follow-up visit six months after ending treatment and receives a diagnosis of CIN II on the E/M claim form.

Select "personal history": You should report a diagnosis of V13.22 (Personal history of cervical dysplasia), not 622.12 (Moderate dysplasia of cervix). Mislabeling her as an active dysplasia patient could affect her ability to get health or life insurance or affect her treatment by other physicians for other conditions, Acevedo says.

Know the threshold: A patient whose condition is treated and who is now seen as follow-up after the completed treatment should have her diagnosis changed to "personal history of" that condition under ICD-9-CM guidelines.