Primary Care Coding Alert

Question: When treating a child with an ear infection, our FP asks the family to schedule a recheck shortly after the patient has finished the antibiotics. We have been assigning V67.59 for the follow-up visit. Is this correct?

Virginia Subscriber

 
Answer: No, it is not correct to use V67.59 (follow- up examination following other treatment) as the primary diagnosis for the second visit. Instead, practices should assign the same diagnosis code used to describe the original illness or condition. In this case, 382.9 (unspecified otitis media) would likely be the code assigned to both office visits. Some payers may request the V code in the secondary position on the claim form, but this is not standard practice.