Oncology & Hematology Coding Alert

It seems that the "V" in V code stands for "very confusing." Used as supplemental codes, they are often mistakenly reported by coders as the primary diagnosis. In most cases, however, V codes should be used as a secondary diagnosis. But, sometimes they should be reported as the primary diagnosis.

"Regular diagnosis codes should go first," says Dianna Hofbeck, RN, CCM, ACFE, president of Northshore Medical in Atlantic City, N.J. "You can't paint a good picture of what happened or why it happened with a V code as the primary diagnosis code."

There are a number of oncology-related V codes: V07.3x Other prophylactic chemotherapy
V10.0-V10.9 Personal history of malignant neoplasm
V16.0-V16.9 Family history of malignant neoplasm
V58.1 Chemotherapy
V66.2-V67.2 Convalescence and palliative care
V76.0-V76.9 Special screening for malignant neoplasms. V58.1 Most Commonly Confused Code V58.1 is perhaps the most common V code used by oncology practices. It looks like a logical primary diagnosis code to describe an encounter with a cancer patient being treated with chemotherapy. However, failing to use the appropriate malignant neoplasm code (e.g., 140-208) may result in denied claims or unfavorable audits because examiners are not able to tell exactly why the patient was being treated in the first place. Hofbeck says V58.1 is a perfectly fine code to help describe the medical necessity of a patient visit for chemotherapy treatment, but it should be used as the secondary diagnosis code. Instead, the primary diagnosis code should describe the cancer that requires chemotherapy. For example, 174.0-174.9 (Breast cancer) should be listed as the primary diagnosis code to describe the medical necessity for breast cancer chemotherapy, and V58.1 should be listed as a secondary diagnosis code.

V codes are supplementary codes intended to add more detail to general diagnosis codes. One of the few exceptions are screenings, says Paula Stinecipher, president and co-founder of AlphaQuest, LLC, a coding consulting firm in Atlanta. However, screenings are usually performed by primary care physicians, not oncologists. Three Tips to Correct V Code Use V codes explain when circumstances other than a disease or injury are why the patient is being treated. Oncology practices should use V codes mainly in three circumstances (as outlined in the ICD-9 manual):

1. When a person who is not currently sick encounters the health services for some specific purpose, such as to act as a donor of an organ or tissue, to receive prophylactic vaccination, or to discuss a problem which is in itself not a disease or injury 2. 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 3. When some circumstance or problem [...]