Otolaryngology Coding Alert

A missing fifth digit could stand in the way of your reimbursement

If you-ve had trouble reporting ICD-9 codes for vaccination-only visits and pneumonia treatments with no diagnoses, then ICD-9's addition of -personal history- and -vaccination not carried out- codes should make your life easier.

Personal History Will Specify Pneumonia

As of Oct. 1, you should no longer lump personal history of pneumonia under the general code V12.6 (... diseases of respiratory system). This fall, V12.6 will require a fifth digit to specify whether the respiratory system disease is:

- unspecified--V12.60

- pneumonia--V12.61

- other--V12.69.

V64.0 Expansion Will Reveal Why -No Vaccination-

The ICD-9 update also includes new V64.0x codes (Vaccination not carried out because of ...) that spell out why a patient didn't receive a vaccination. An insurer will be able to tell whether your allergist didn't carry out a vaccination because the child had a fever (V64.01, ... acute illness) or the caregiver refused the service (V64.05, ... caregiver refusal), says Daniel S. Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City. The current code V64.0 (... contraindication) or V64.3 (Procedure not carried out for other reasons) doesn't allow you to specify why the patient didn't receive the vaccination.

Bonus: The 10 new codes will allow better immunization tracking to account for missed or delayed vaccinations. In fact, V64.0x could help combat denials or incorrect preventive-medicine benefit allotments for the problematic return-for-vaccine visit.

-These codes will demonstrate why the patient had to come in for a separate visit to receive the immunization,- says Sherry Wilkerson, RHIT, CCS, CCS-P, coding and compliance manager at Catholic Healthcare Audit Network in Clayton, Mo.