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Pediatric Coding Alert

Using V Codes to Your Best Advantage? Experts Tell How

Published on Sat Dec 06, 2003

V codes alone may not have the power to bring in reimbursement, but under certain circumstances you may need to use them to illustrate to the payer why your physician performed - and should be reimbursed for - a given procedure.
 
For instance, if a pediatrician sees adolescents who need emergency contraception counseling and prescription, the physician may use code V25.03 (Encounter for contraceptive management; general counseling and advice; encounter for emergency contraceptive counseling and prescription) to describe
the encounter.
 
V codes represent factors influencing a patient's health status and contact with health services. You should use V codes to represent the following, according to the AMA's Principles of ICD-9 Coding:
 

  • When a person who is not now sick uses health services for some specific purpose, such as to act as a donor of an organ or tissue, to receive vaccinations, to discuss a problem that is not classified as a disease or an  injury, to seek consultation for family planning, or for general medical examinations.
     
  • When a patient has a disease or injury and needs a specific treatment for that problem, such as dialysis or chemotherapy.
     
  • When a person encounters some circumstance or problem that influences his health status but is not in itself a current illness or injury.

    One thing many coders don't realize is that V codes can serve as both secondary and primary diagnosis codes; it is your responsibility to report them in either situation.

    When V Codes Are OK as Primary Diagnoses

    Don't be scared of reporting V codes as primary diagnoses - especially when the patient's visit is for a screening, a well-patient exam, or to monitor the effects of a drug.
     
    For example, an infant presents with no physical symptoms for a scheduled preventive medicine checkup. In this case, you should choose a V code (such as V20.2, Routine infant or child health check) to represent the routine exam and link it to the service code 99381 (New patient preventive medicine services) as the primary diagnosis.
     
    Your carrier may not reimburse office visits that are linked to diagnosis codes that do not represent a condition or symptom. But if the patient does not have any symptoms, you should not list a non-present diagnosis code simply for reimbursement purposes - you would be committing fraud.
     
    Also, you may need to use the V codes as primary diagnosis codes when a patient is receiving aftercare as continued treatment or to prevent recurrence.

    V Codes Are Secondary for Follow-Up

    You can't use just any V code as a primary diagnosis code; some are exclusively secondary codes.

    You should use V codes as secondary and tertiary diagnosis codes to further explain how a patient's symptoms or condition originated. For example, there are V codes to indicate follow-up (V67.59, Follow-up exam; following other treatment; other; V67.9, Unspecified follow-up examination; and V72.8x, Other specified examinations). Typically, carriers prefer that you list the primary diagnosis, e.g., otitis media (382.9), first and list V67.59 second, for the follow-up visit. 

    "There is real argument among coding experts as to what is the most appropriate way to use these codes," says Richard H. Tuck, MD, FAAP, a member of the American Academy of Pediatrics national committee on coding and nomenclature. Some say you should first list the primary diagnosis for which they are being followed up. Others say to list V67.59 (Following other treatment; other). The problem with the latter is that some insurance companies will kick that out.
     
    Much of this depends on individual payer guidelines, but you can use V codes to modify primary diagnosis codes.

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