Otolaryngology Coding Alert

Question: A male patient who is two years post- carcinoma of the larynx sees the otolaryngologist in the office. His only complaint is that he becomes hoarse when he forgets to take his Prevacid. The otolaryngologist performs a flexible laryngoscopy (31575) and finds no evidence of regional or local recurrence. Which ICD-9 code should we use for the visit? We have been using V10.21 (personal history of malignant neoplasm, larynx).

Ohio Subscriber

Answer: Given the information provided, hoarseness (784.49) is an appropriate primary diagnosis. It is considered a sign or symptom, which means it is not a definitive diagnosis. Even so, signs or symptoms can be useful diagnoses. Codes 780-799 in the ICD-9 manual all  describe "symptoms, signs and ill-defined conditions" that frequently provide medical necessity for the visit. In this case, the patient's chief complaint is hoarseness after not taking Prevacid, which is an acid suppressant. Without the Prevacid, the unsupressed acid causes reflux, which, in turn, can cause hoarseness.
 
V codes are usually included, when appropriate, as a second (or third, etc.) diagnosis, although in some cases they may be correctly used as a primary diagnosis. In this case, the hoarseness diagnosis is a better choice on two counts: It is more specific than the V code, and it is more likely to be an accepted diagnosis.