Ophthalmology and Optometry Coding Alert

Reluctance to use V codes may keep valuable info from patients' records

A patient arrives in your office for a contact fitting, but the best way to describe why the patient is there is with a V code - and that's not necessarily a bad thing. Coders often shun V codes because 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 carriers' coffers.

Demystify These Harmful Myths

Myth #1: V codes are only secondary diagnosis codes, like E 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 patient reports to the ophthalmologist just to be fitted for contacts. In this case, you want to report a V code (V53.1, Fitting and adjustment of spectacles and contact lenses) because fitting of the contacts is the procedure you perform.

V codes as primary diagnoses also come into play with Medicare's screening services. Many Medicare-covered screening tests, including glaucoma screening, require you to link the main procedure code to a V code. Link V80.1 (Special screening for neurological, eye, and ear diseases; glaucoma) to G0117 (Glaucoma screening for high-risk patients furnished by an optometrist or ophthalmologist).

Solution: The V code descriptor will indicate whether you may report the code as a primary or secondary diagnosis code with the indicators "PDx" (primary) and "SDx" (secondary).

If the code has neither designation, the ICD-9 manual states you may use it as either a primary or a secondary diagnosis.

Myth #2: V codes don't pay anything, so there is no reason to use them.

Although some V codes have descriptors that give only the patient's background information, the information they provide can help support the complexity or frequency of an E/M code your office reports, or they can support the medical necessity of a diagnostic test, says Jean Acevedo, LHRM, CPC, CHC, senior consultant with Acevedo Consulting Inc. in Delray Beach, Fla.

Example: A patient taking Plaquenil for her arthritis needs to have her eyes monitored to make sure the drug is not harming the lens or retina. The patient, who is otherwise healthy, undergoes visual field tests.

In this case, a V code that shows the patient is on a drug long-term, such as V58.69 (Long-term [current] use of other medications), will help to substantiate the need for these tests to the patient's insurance carrier, says Jody Hemberger, RN, CPC, coder for Eye Surgical Consultants in Lincoln, Neb. Without it, the tests appear medically unnecessary.

Don't overlook: Be sure to code the patient's systemic condition - such as lupus (710.0, Systemic lupus erythematosus) or rheumatoid arthritis (714.x, Rheumatoid arthritis and other inflammatory polyarthropathies) - as the secondary diagnosis, Hemberger says.

Prove the Myth-Perpetrators Dead Wrong

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 submits them for counseling and histories, she says. The codes she reports most include: