Pediatric Coding Alert

My understanding has been that I cannot bill for "family history of" a condition. I recently read some advice about billing for "personal history of." I realize these aren't exactly the same, but would like to clarify whether these are valid diagnoses.

Answer:

The "V" codes for family history are perfectly good, billable codes; you should report them when pertinent to the encounter. However, some payers will not reimburse for all V codes listed as the primary code on the claim.

Caution: It's never correct to use a "personal history of" code instead of a "family history of" code just in hopes of getting paid. "Personal history" means that the patient has a history of a certain condition (such as V12.04 [Personal history of methicillin-reisistant staphylococcus aureus, MRSA]). These V codes are also great codes and often very important to the encounter -- but, as noted, some payers don't generally reimburse for V codes if they are the first code listed. Also note that some personal history codes (such as V14.0, Personal history of allergy to medicinal agents; penicillin) are secondary diagnosis codes only. It is still the correct way to code for the encounter when there is not another primary diagnosis.