Orthopedic Coding Alert

Talking with a patient (or his or her surrogate) with undiagnosed, early-stage Alzheimers disease or dementia about the risks and benefits of a hip replacement might take extra physician time. And the physician carefully must document the amount of time spent with the patient in counseling and coordinating care to code for the allowable evaluation and management (E/M) service. (See related article on page 27.) But coding should not stop there.

The supplementary ICD-9 code V40.9 (unspecified mental or behavioral problem) should be recorded in addition to the relevant musculoskeletal diagnosis for the patient, such as osteoarthrosis of the hip (e.g., 715.15, osteoarthrosis, localized, primary, pelvic region and thigh).

V codes, although not often used as primary diagnosis codes (and some cannot be used for a primary diagnosis), are important. Using V codes allows a practice to monitor services rendered to patients for studies, statistics and also as a mechanism for defending requests to managed-care companies for additional reimbursement for more difficult cases, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C.

If you have not documented difficult cases by way of a diagnosis code, continues Callaway-Stradley, it is difficult, if not impossible, to present useful information to another party.

Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Systems Inc., a medical billing firm in Broomfield, Colo., agrees and says, When appropriate, use [V codes]. Page says some of the codes are particularly useful in supporting a diagnosis. She gives V58.69 (long-term [current] use of other medications high-risk medications) as an example.

But Page cautions against using V codes indiscriminately. I would not use them unless they directly related to the visit, she says.

Noting an acquired absence of a breast (V45.71) would be unnecessary if the patient arrived for treatment of a fractured middle finger (816.11, open fracture of middle phalanx). But reporting that a patient is dependent on a respirator (V46.1) is useful if it bears on a medical decision, such as treating a closed fracture of the shaft of the humerus (812.21). In other words, it might help explain the choice of closed manipulation (24505, closed treatment of humeral shaft fracture; with manipulation) instead of a surgical intervention (e.g., 24515, open treatment of humeral shaft fracture with plate/screws, with or without cerclage).

Health Status vs. Aftercare

Codes in the series V40-V49 (persons with a condition influencing their health status) and V51-V59 (persons encountering health services for specific procedures and aftercare) are particularly relevant to orthopedic practices.

Health Status: Many codes in the V40-V49 series document conditions that grow more common with age, such as problems with sight (V41.0) and problems with hearing (V41.2). Physicians serving an elderly population [...]