Primary Care Coding Alert

Tell insurers why pneumonia rx w/o dx and shot not given

Pneumonia and urinary tract infection treatment without diagnosis and
vaccination-only encounters may be easier to explain this fall thanks to ICD-9's addition of "personal history" and "vaccination not carried out" codes.

Personal History Will Specify Treated, Undiagnosed UTI

When your family physician prescribes treatment for a patient who has a personal history of a disease but the physician doesn't note any signs and symptoms or a definitive diagnosis - or the test comes back negative - does the ICD-9 code stump you? Then, you'll welcome two new V codes for personal history of specific diseases, such as pneumonia (V12.61, Personal history, pneumonia [recurrent]) and urinary tract infection (UTI) (V13.02, ... urinary [tract] infection).

Example: A female patient who has had multiple previous UTIs presents with a complaint of burning when urinating. Although the urinalysis comes back negative, the FP prescribes antibiotic treatment because of the patient's personal history of UTIs.

New way: This is the perfect time to use V13.02 with the E/M code (such as 99212-99215, Office or other outpatient visit for the evaluation and management of an established patient). "When a patient's personal history affects the patient's health status, you should use the V10-V15 series (Personal history of ...)," says Jeffrey Linzer Sr., MD, MICP, FAAP, representative to the ICD-9-CM editorial advisory board. Select the appropriate V code that correlates to the patient's illness.

Old method: You would now lump personal history of UTI under the general code V13.09 (Personal history of other diseases; disorders of urinary system; other). This fall, ICD-9 will contain a specific subclassification to indicate that a patient requires treatment due to past UTIs.

As of Oct. 1, you should no longer lump personal history of pneumonia under the general code V12.6 (... diseases of respiratory system). This fall, V12.6 will require a fifth digit to specify whether the respiratory system disease is:

unspecified - V12.60
pneumonia - V12.61
other - V12.69.

V64.0 Expansion Will Reveal Why 'No Vaccination'

The ICD-9 update also includes new V64.0x codes (Vaccination not carried out because of ...) that spell out why a patient didn't receive a vaccination. An insurer will be able to tell whether you didn't carry out a vaccination "because the child had a fever (V64.01, ... acute illness) or the caregiver refused the service (V64.05, ... caregiver refusal)," says Daniel S. Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City. The current code V64.0 (... contra-indication) or V64.3 (Procedure not carried out for other reasons) doesn't allow you to specify why the patient didn't receive the vaccination.
 
Bonus: The 10 new codes will allow better immunization tracking to account for missed or delayed vaccinations. In fact, V64.0x could help combat denials or incorrect preventive medicine benefit allotments for the problematic return-for-vaccine visit.
 
"These codes will demonstrate why the patient had to come in for a separate visit to receive the immunization," says Sherry Wilkerson, RHIT, CCS, CCS-P, coding and compliance manager at Catholic Healthcare Audit Network in Clayton, Mo.