Pathology/Lab Coding Alert

Supplementary classification shows medical necessity or patient history

If you think V codes only provide -extra- information, think again. In fact, they are key elements to successful claims. Here are two examples in which V codes can turn a potential denial into payment:

Scenario 1: Watch for Long-Term Drug Use

A patient taking Celebrex for her arthritis needs to have her liver and kidney functions monitored to ensure the drug isn't causing problems. The patient, who is otherwise healthy, undergoes lab tests every few months to monitor kidney and liver functions.

V code to the rescue: To help substantiate the need for these tests to the patient's carrier, report a V code that shows the patient is on a drug long-term, such as V58.64 (Long-term [current] use of non-steroidal anti-inflammatories [NSAID]).

Why? The information that V codes provide can help support a claim's medical necessity, such as a repeated lab test, says Jean Acevedo, LHRM, CPC, CHC, senior consultant with Acevedo Consulting Inc. in Delray Beach, Fla.

Scenario 2: Don't Miss History of Disease

You can also use V codes to explain follow-up testing based on the history of the disease. For instance, when the lab performs a PSA test (84153, Prostate specific antigen [PSA]; total) ordered after successful treatment for a prostate cancer patient, you should not use a prostate cancer diagnosis code (185, Malignant neoplasm of prostate). Instead, report V10.46 (Personal history of malignant neoplasm; prostate).

Pitfall: Acevedo often sees physicians failing to use V codes on patients whose disease process is no longer active. Mislabeling a patient as an active cancer patient could affect his ability to get health or life insurance or affect his treatment by other physicians for other conditions, Acevedo says.

Don't miss: Sometimes -history of- codes are the most accurate descriptors of the reason for the patient encounter. ICD9 Codes doesn't designate the V10 codes (Personal history of malignant neoplasm) as either primary or secondary codes, meaning you can report them as either.

Payers may be more likely to deny claims that list a V code as the primary diagnosis on the claim, says Michael A. Granovsky, MD, CPC, FACEP, vice president of MRSI, a coding and billing company in Stoneham, Mass. But you can't choose your codes based on payment. You should follow the official coding guidance available at www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide05.pdf.

Use V Codes for Screening Lab Tests

If your lab performs testing for Medicare screenings, here are some special screening codes you should use on your claims--and keep for future reference:

- V76.2--Special screening for malignant neoplasms; cervix
- V76.41--- rectum
- V76.44--... prostate
- V76.47--... vagina
- V76.49--... other sites
- V76.51--- colon
- V77.1--Special screening for endocrine, nutritional, metabolic, and immunity disorders; diabetes mellitus
- V81.0--Special screening for cardiovascular, respiratory and genitourinary diseases; ischemic heart disease
- V81.1--... hypertension
- V81.2--... other and unspecified cardiovascular conditions.