Ophthalmology and Optometry Coding Alert

Know best practices for reporting transport accidents that cause injuries.

ICD-10-CM 2023 adds hundreds of new V codes from which you can choose. While most ophthalmology coders are familiar with these codes, many admit to being unsure of the specifics surrounding their use. As code options continue to expand, make sure you don’t miss a beat by brushing up on the basics of V code billing.

Why? Using V codes to paint a complete picture of a patient’s situation could help streamline claims submission and payment settlement.

Bust these five common myths about external cause reporting that will provide you with up-to-date information about proper application of these codes.

Myth 1: V Codes Can Be Reported Alone

Reality: You should never report just a V code, as they only provide information on how an injury or health condition happened. Instead, pair them — and all other external cause codes — with a code in the ranges of A00.0-T88.9 and Z00-Z99, which describe a health condition due to an external cause.

Hint: When looking for the right code, remember that the codes in categories V00-V99 are classified into 12 groups, which reflect the person’s mode of transport. The first two characters of the code identify the vehicle — V1 for pedal cycle rider, V2 for motorcycle rider, V4 for car occupant, and V5 for occupant of pickup truck or van, etc. — and the codes describing accidents on land (V00-V89) are subdivided to identify the type of event.

Myth 2: Claims Must Include an External Cause Code

Reality: Section I.C.20 of the ICD-10-CM Official Guidelines states, “There is no national requirement for mandatory ICD-10-CM external cause code reporting.” It goes on to explain that reporting codes from Chapter 20 is voluntary unless the provider is bound by a state-based external cause code reporting mandate, or a particular payer requires use of these codes. This means doing your research and knowing what your state may require.

Myth 3: Skipping V Codes Has No Bearing

Reality: External causes of morbidity codes back up your claims and explain what happened when the injury occurred. They also provide data for injury research and evaluation of injury prevention strategies. V codes not only inform insurance companies when processing claims but also state legislators to improve safety laws.

Dig deeper: “The use of the external cause codes is necessary to ensure accurate billing and application of benefits,” explains Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California. “These codes will allow an insurance carrier or billing department to clearly see when there may be a third-party payer involved. In the case of benefits, it may affect the patient liability, as it could affect the application of the deductible or co-insurance allowance,” Johnson adds. “For instance, using an external causes code to denote a patient’s injury is due to an auto accident will let the patient’s health insurance carrier know that an automobile insurance carrier (e.g., the patient’s or that of another driver) may be liable for the cost of the services.”

Myth 4: Never Assign More Than 1 External Cause Code

Reality: You can report multiple external cause codes, as many as you need to fully explain each cause. “Use the full range of external cause codes to completely describe the cause, intent, place of occurrence, and, if applicable, the activity of the patient at the time of the event, and the patient’s status, for all injuries, and other health conditions due to an external cause,” instructs the ICD-10-CM guidelines.

Myth 5: V Codes Can Be Assigned as First-Listed Diagnosis

Reality: You should never sequence a V code as the principal diagnosis. This applies to all external causes of morbidity codes. Payers do not accept them as primary, as they describe the cause of the morbidity, not the condition itself.

Example: A 52-year-old patient presents complaining of seeing floaters in a portion of his left eye, with vision blurred in that area. He states the symptoms began following a bicycle accident three weeks prior, and they have worsened over time since that happened. The physician suspects retinal detachment, but upon examination, diagnoses the patient with a horseshoe retinal tear with no detachment.

In this case, you would report H33.312 (Horseshoe tear of retina without detachment, left eye) for the primary diagnosis. You can assign an external cause code as a secondary diagnosis to describe the bike accident, such as V18.0XXA (Pedal cycle driver injured in noncollision transport accident in nontraffic accident, initial encounter), if you can directly correlate the tear to the bicycle injury.

 Pointer: You should assign an external cause code with the appropriate 7th character for each encounter in which your provider is treating the injury or condition. Use the 7th character:

• Initial encounter (A) for encounters in which the patient is receiving active care for the condition.
• Subsequent encounter (D) for encounters after the patient has received active treatment for the injury and is receiving routine care during the healing or recovery phase.
• Sequela (S) for complications or conditions that arise as a direct result of the injury.