Otolaryngology Coding Alert

Stay abreast of reporting transport accidents that cause injuries.

The 2023 ICD-10-CM code set adds a plethora of new V codes from which you can choose. While most otolaryngology 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 what these codes are and how to bill them.

V codes capture certain details about an injury or health event and using them to paint a complete picture could help streamline claims submission and payment settlement. Read on to get the 411 on these codes and shore up your knowledge of appropriate use of V codes and application of their guidelines.

What Are V Codes?

V codes, which make up a sizable portion of the codes in Chapter 20, External Causes of Morbidity, provide information on how an injury or health condition happened. You may use them (and all other external cause codes) with any code in the ranges of A00.0-T88.9 and Z00-Z99. Never report them alone.

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 — for example, V1 for pedal cycle rider, V2 for motorcycle rider, V4 for car occupant, and V5 for occupant of pickup truck or van — and the codes describing accidents on land (V00-V89) go one step further, subdivided to identify the type of event.

Now that you have a solid understanding of V codes, let’s address the five most frequently asked questions on using and reporting them properly.

Do I Have to Report External Cause Codes?

No. “There is no national requirement for mandatory ICD-10-CM external cause code reporting,” per ICD-10-CM Official Guidelines, Section I.C.20. The guideline 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 is requiring use of these codes. This means doing your research and knowing what your state may require.

Why Is it Important to Report External Cause Codes?

External causes of morbidity codes back up your claims and explain what happened when the injury occurred. Their main purpose is to 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.

“Different states track injury prevention. For example, when there was a spate of ATV [all-terrain vehicle] accidents, an external cause code was added to track these accidents. They were looking at the number of those types of injuries, and researchers were looking at what types of strategies could prevent them,” explains Sarah Glass, MA, RHIA, CCS, FAHIMA, an AHIMA-approved ICD-10-CM/PCS trainer.

Can V Codes Be Assigned as a Principal Diagnosis?

No. Never sequence V codes as the first-listed or 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.

Do V Codes Require a 7^th Character?

Yes. V codes come into play during both the initial time of care and follow-up treatment. Use the 7th character:

• Initial encounter (A) for encounters in which the patient is receiving active care for the condition, even if a different physician is providing the active medical or surgical treatment.
• 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 (e.g., X-ray to check fracture healing status, medication adjustment, and other aftercare and follow-up visits subsequent to injury treatment).
• Sequela (S) for complications or conditions that arise as a direct result of an injury, such as scar formation after a burn.

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.

Can I Report More Than 1 V Code?

Yes, you can use multiple V codes. Assign as many codes 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. But if you are only able to use one external code, report the code most related to the principal diagnosis.