Pathology/Lab Coding Alert

Use ICD-9 changes to confirm reason for lab tests

If you're looking for a better way to specify why you're performing a lab test for patients with no current signs or symptoms of disease, you'll soon have some new tools at your disposal.

Thanks to new ICD9 Codes that go into effect Oct. 1, additional V codes will help you show medical necessity when a physician orders lab procedures for genetic testing, egg donation, blood typing, or based on history of disease.

You Can Show Medical Necessity With V Codes

When you perform a procedure for circumstances other than a disease or condition that you can classify with ICD-9 codes 001-999, you may need a V code to explain the situation, says Laurie Castillo, CPC, CPC-H, CCS-P, owner of Castillo Consulting in Manassas, Va.

Medicare and other payers may accept V codes to show medical necessity for certain lab procedures. "Sometimes a V code alone establishes the reason for the procedure, but sometimes you should use the V code as a secondary diagnosis," Castillo says.

Example: A physician may use new ICD-9 code V72.86 for blood typing encounters to order Rh phenotyping (86906, Blood typing; Rh phenotyping, complete) for a father to help assess the possibility of Rh incompatibility and hemolytic disease of newborn.

Choose Specific 'History of' Codes

Starting Oct. 1, ICD-9 lists eight new codes for personal or family history of disease, which you can see in the following table. By adding some specific five-digit codes for history of different respiratory conditions and musculoskeletal disease, ICD-9 also eliminates the four-digit codes V12.6 and V17.8 that you now use to report these circumstances. "You'll have to start using the appropriate five-digit code on Oct. 1," Castillo says.

ICD-9 also adds new codes V13.02 and V13.03 under existing subcategory code V13.0x (Personal history of disorders of the urinary system), which requires a fifth digit. The code set also adds V18.9 for history of genetic disease carrier under category V18.x (Family history of certain other specific conditions). "The physician may use this code to order testing to see if a patient carries the gene for a specific disease when family members are known carriers," Castillo says. 

Egg Donor Codes Explain Reproductive Procedures

The lab may perform certain procedures such as isolating eggs (89254, Oocyte identification from follicular fluid) and storing them (89346, Storage [per year]; oocyte[s]) when a patient donates eggs. "New codes V59.70-V59.74 provide a way to link the egg donation and the lab procedures for processing the eggs," Castillo says. 

Describe Prenatal Tests With V Codes

When a physician orders genetic testing to help patients understand their risk of passing on inherited disease, two new ICD-9 codes help the physician describe more specifically the reason for the testing. "Codes V26.31 and V26.32 allow you to distinguish between genetic testing and counseling for patients with known carrier status and those without," Castillo says. ICD-9 invalidates four-digit code V26.3, which now describes both conditions.

Physicians can also use two revised V codes to describe the reason for ordering certain lab tests on amniotic fluid. For example, the physician may order an alpha-fetoprotein test (82106, Alpha-fetoprotein; amniotic fluid) to help assess the risk of potential birth defects and report V28.1 as the reason for the test. The physician may also order a test such as 88267 (Chromosome analysis, amniotic fluid or chorionic villus, count 15 cells, 1 karyotype, with banding), using revised ICD-9 code V28.0.

Access Changes Early - Grace Period Is Gone

You should be used to having no 90-day grace period for implementing new ICD-9 codes - this is the second year without the cushion. You shouldn't encounter many coding difficulties or denials, as long as you update your code set by Oct. 1, says Melanie Witt, RN, CPC, MA, an independent coding consultant in Fredericksburg, Va. You can access a complete list of changes in the May 4 Federal Register, so you should have enough time to make the changes.

ICD-9 Code        CodeDefinition                                                                                Code Status (effective Oct. 1)  
V12.6          Personal history of diseases of the respiratory system                                           invalid 

V12.60        Personal history of unspecified disease of respiratory system                                    new 

V12.61        Personal history of pneumonia (recurrent)                                                                 new 

V12.69        Personal history of other diseases of respiratory system                                            new 

V13.02        Personal history of urinary (tract) infection                                                                new 

V13.03        Personal history of nephrotic syndrome                                                                    new 

V17.8          Family history of other musculoskeletal diseases                                                    invalid 

V17.81        Family history of osteoporosis                                                                                  new 

V17.89        Family history of other musculoskeletal diseases                                                       new 

V18.9          Family history of genetic disease carrier                                                                    new

V26.3          Procreative management; genetic counseling and testing                                         invalid 

V26.31        Procreative management; testing for genetic disease carrier status                              new 

V26.32         Procreative management; other genetic testing                                                          new 

V26.33         Genetic counseling                                                                                                 new 

V28.0           Antenatal screening for chromosomal anomalies by amniocentesis                         revised
 
V28.1           Antenatal screening for raised alpha-fetoprotein levels in amniotic fluid                      revised 

V59.7           Donors, egg (oocyte) (ovum)                                                                               new subcategory 

V59.70         Donors, egg (oocyte) (ovum) donor, unspecified                                                         new 

V59.71         Donors, egg (oocyte) (ovum) donor, under age 35, anonymous recipient                      new 

V59.72         Donors, egg (oocyte) (ovum) donor, under age 35, designated recipient                       new
 
V59.73         Donors, egg (oocyte) (ovum) donor, age 35 and over, anonymous recipient                  new 

V59.74         Donors, egg (oocyte) (ovum) donor, age 35 and over, designated recipient                   new
 
V72.86         Other specified examinations, encounter for blood typing                                           new