Pathology/Lab Coding Alert

V codes can document the need for a test

Don't shun V codes because you believe some long-standing - but highly inaccurate - coding lore. The truth: V codes can be the key to showing medical necessity for tests that your lab performs for chronic conditions, screening, or due to underlying circumstances that affect health status.

Find out if ignoring V codes is locking you out of lab-test payment.

Demystify These Harmful Coding Beliefs

Myth #1: V codes are only secondary diagnosis codes, like E codes.

"There are times when it's very appropriate to report V codes as a primary code," says Suzan Hvizdash, BSJ, CPC, physician education specialist for the University of Pennsylvania in Pittsburgh.

Example: The lab examines a Pap smear taken once every three years for a patient who has no signs or symptoms of disease. You should report a V code (such as V76.2, Special screening for malignant neoplasms; cervix), because you're performing a screening test like P3000 (Screening Papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision). Medicare requires a V code to indicate medical necessity for screening Pap smears.

Solution: The V code descriptor will indicate whether you may report the code as a primary or secondary diagnosis code with the indicators "PDx" (primary) and "SDx" (secondary). If the code has neither designation, the ICD-9 manual states you may use it as either a primary or a secondary diagnosis code.

Myth #2: V codes only give supplementary information, so there is no reason to use them.

While it's true that some V codes are only descriptors that give background information on the patient, the information they provide can help support the medical necessity of a claim, such as a repeated lab test, says Jean Acevedo, LHRM, CPC, CHC, senior consultant with Acevedo Consulting Incorporated in Delray Beach, Fla.

Example: A patient taking Celebrex for her  arthritis needs to have her liver and kidney functions monitored to make sure the drug is not causing any problems. The patient, who is otherwise healthy, undergoes lab tests every few months to monitor kidney and liver functions.

In this case, 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]) will help to substantiate the need for these tests to the patient's insurance carrier. Without it, the tests may appear medically unnecessary.

History example: 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 a year after successful treatment for a prostate cancer patient, you should not use a prostate cancer diagnosis (185, Malignant neoplasm of prostate).

Pitfall: Acevedo often sees physicians failing to use V codes on patients whose disease process is no longer active. 

Select 'personal history': In this instance, you should report a diagnosis of V10.46 (Personal history of malignant neoplasm; prostate), not 185. Mislabeling him 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.

Know the threshold: A patient who is cancer-free for one year is considered clean and should have his diagnosis changed to "personal history of cancer."

Ramp Up Your V Code Basics

You should use V codes to classify factors that influence health status and reasons for lab services. ICD-9 classifies V codes into three general categories:

 When a person who is not sick encounters health services for some specific purpose, such as to act as the donor of an organ or tissue, to receive a prophylactic vaccination, or to discuss a disease or injury 

Example: V59.3 - Donors; bone marrow

 When a person with a known disease or injury, whether it is current or resolving, encounters the healthcare system for a specific treatment of that disease or injury (e.g., dialysis for renal disease, chemotherapy for malignancy, cast change)

Example: V56.0 - Encounter for extracorporeal dialysis

 When some circumstances or problem is present that influences the patient's health status but is not in itself a current illness or injury 

Example: V83.81 - Genetic carrier status; cystic fibrosis gene carrier.

Note: Other than screening Pap tests mentioned in this article, Medicare uses V codes as primary diagnoses for several other screening services. For a list of relevant V codes, see the box "Forget These Screening Codes? Forget Payment From CMS" for more information.