Pathology/Lab Coding Alert

We'll tell you how to use 3 new V codes

Physicians sometimes order lab tests to monitor patient response to medication - but your lab can't get paid without showing medical necessity. ICD-9-CM 2004 adds three new, specific drug-use V codes you'll have to use, according to CMS' National Coverage Determinations (NCD) and other guidelines.

New ICD-9 Codes Are More Specific

Effective Oct. 1, ICD-9 added three new five-digit codes under V58.6x (Long-term [current] drug use). The new codes are:

V58.63 - Long-term (current) use of antiplatelet/antithrombotic

V58.64 - Long-term (current) use of non-steroidal anti-inflammatories (NSAID)

V58.65 - Long-term (current) use of steroids.

The subcategory already included the following subclassification codes:

V58.61 - Long-term (current) use of anticoagulants

V58.62 - Long-term (current) use of antibiotics

V58.69 - Long-term (current) use of other medications.

"The biggest change you'll see is that many tests which you previously reported using the 'other medications' code V58.69, you'll now have to report with one of the new codes," says Anne Pontius, MBA, CMPE, MT (ASCP), president of Laboratory Compliance Consultants Inc., in Raleigh, N.C. "You should only report a 'not otherwise specified' ICD-9 code if a more specific code is not available." Experts offer the following advice on using the three new codes accurately:

1. Use V58.64 for Aspirin and Other NSAIDs

Although physicians previously ordered lab tests to monitor the effects of long-term NSAID use with V58.69, they should now report the more specific code, V58.64. Physicians often prescribe NSAIDs for long-term inflammatory disease treatment, and the drugs can cause blood thinning and stomach irritation.

That's why CMS added V58.64 as a payable diagnosis to the fecal-occult blood test NCD. "If a physician orders a guaiac-based fecal blood test [82270, Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, 1-3 simultaneous determinations] to evaluate possible stomach bleeding in a patient taking aspirin or Daypro, for example, the physician should use V58.64 as the ordering diagnosis," Pontius says. CMS also added V58.64 as a payable diagnosis to NCDs for the following tests:

Blood glucose

82947 - Glucose; quantitative, blood (except reagent strip)

82948 - ... blood, reagent strip

82962 - Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use

Lipid

80061 - Lipid panel

82465 - Cholesterol, serum or whole blood, total

83715 - Lipoprotein, blood; electrophoretic separation and quantitation

83716 - ... high-resolution fractionation and quantitation of lipoprotein cholesterols (e.g., electrophoresis, nuclear magnetic resonance, ultracentrifugation)

83718 - Lipoprotein, direct measurement; high- density cholesterol (HDL cholesterol)

83721 - Lipoprotein, direct measurement, LDL cholesterol

84478 - Triglycerides

Gamma glutamyltransferase

82977 - Glutamyltransferase, gamma (GGT).

2. Report V58.63 for Antiplatelet Meds

In the past, physicians may have reported long-term use of antiplatelet or antithrombotic medication using code V58.61, because they are types of anticoagulant (anticlotting) drugs. "Physicians should now report V58.63 for long-term use of antiplatelet drugs such as Plavix and antithrombotic drugs such as heparin, because their mode of action distinguishes them from other anticoagulants," says Lisa Johnson, CPC, CCS-P, CHC, CMC, senior healthcare consultant at Gates, Moore & Company in Atlanta.

Antiplatelet drugs discourage clotting by inhibiting platelet aggregation. Antithrombotics block clot formation by reducing thrombin activity. Other common anticoagulants, such as Coumadin, act by blocking clotting factors in the bloodstream.

If a physician orders a lipid panel (80061) or other lipid test for a patient on Plavix for atherosclerosis, the physician should now report V58.63 rather than V58.61, along with the code for the underlying condition (such as 440.8, Atherosclerosis of other specified arteries).

CMS also added V58.63 as a payable diagnosis to NCDs for blood glucose (82947-82948 and 82962), gamma glutamyltransferase (82977), and fecal-occult blood (82270).

3. Continue to Use V58.61 for Coumadin

Because Coumadin is an anticoagulant that is not an antiplatelet or antithrombotic, you should continue to report V58.61 for monitoring patients on that drug. "For example, physicians should report V58.61 as the ordering diagnosis for a prothrombin time test (85610, Prothrombin time) ordered to monitor Coumadin therapy," Johnson says. The physician may also report the underlying condition, such as 427.31 (Atrial fibrillation).

4. Use V58.65 for Steroids

When physicians order lab tests to monitor the effects of long-term steroid use, they should now report V58.65 as the ordering diagnosis rather than the more general code, V58.69. "For example, if a physician orders collagen cross links (82523, Collagen cross links, any method) to evaluate secondary osteoporosis in a patient on glucocorticosteroid medication, the physician should report V58.65 as the ordering diagnosis," Johnson says. CMS also added V58.65 as a payable diagnosis for blood glucose (82947-82948 and 82962) and fecal-occult blood (82270) NCDs.

Not All V Codes Are Primary Diagnoses

"Remember that you cannot use all V codes as primary diagnoses," Johnson says. Although ICD-9 2003 does not designate the V58.6 series as secondary diagnosis codes, you'll need to confirm the designation in ICD-9 2004 before using them as primary diagnoses. The ICD-9 tabular list (Volume 1) typically indicates secondary codes with a symbol that is defined at the bottom of the page, such as SDx.

Make Sure You Have Documentation

Now that you know how to use these codes, make sure your physician clients do too, because the lab has to report the ordering physician's diagnosis. If you don't have documentation supporting these new V codes as the reason for the test, you can't report them. Without a payable diagnosis, you'll need to get a signed advance beneficiary notice so you can bill the patient for the test.