Primary Care Coding Alert

Surprise: You'll find the V71 series useful for suspected non-ill cases If you automatically assign V65.5 whenever your family physician doesn't have a clear diagnosis for a pediatric visit, you could be overlooking two more appropriate V code series: V67 and V71.
 
For an encounter in which a child who has a history of otitis media (OM) is not now ill, coders recommend reporting V65.5 (Person with feared complaint in whom no diagnosis was made) in the secondary position, writes Carol Miller, CPC, coder in the charge entry department of the Family Health Center in Orlando, Fla. "What diagnosis should you use in the first position?"
 
Find out how ICD-9 experts recommend coding three "well check" scenarios. 1. Use V71 Series for Nonsymptomatic Rule Out Because ICD-9 disallows rule outs or suspected conditions, coding an unfound injury proves problematic. But you can code these encounters as examinations for unfounded suspected conditions (V71.x, Observation and evaluation for suspected conditions not found).
 
You should use this category "when persons without a diagnosis are suspected of having an abnormal condition, without signs or symptoms, which requires study, but after examination and observation, is found not to exist," state ICD-9's instructions following V71.
 
Scenario: A family physician sees a child for a suspected "broken [fore]arm." There is no sign or symptom of a break, and the FP rules out the condition.
 
Solution: You should report the E/M services (such as 99201-99215, Office or other outpatient visit for the evaluation and management of a new or established patient ...) with V71.89 (Observation and evaluation for other specified suspected conditions).
 
When a physician rules out a suspected condition, you should use the V71 series, says Jeffrey Linzer Sr., MD, MICP, FAAP, representative to the ICD-9-CM editorial advisory board.

2. Let Symptom Override V Code If the FP makes a diagnosis or documents a sign or symptom, you should instead report the problem with the appropriate ICD-9 code.
 
For instance, in the suspected broken forearm scenario, "if the child had just hurt his arm and there was no fracture, you would use the code for '[fore]arm injury' (959.3, Injury, other and unspecified; elbow, forearm and wrist)," Linzer says. Because the physician was able to diagnose an injury - albeit not a break - to the arm, the use of 959.3 rather than V71.x is appropriate
 
Anther example: After her 6-month-old baby rolls off the bed, a mother brings the infant to the FP to make sure he's OK. The physician examines the baby and finds no bruising, swelling, [...]