Primary Care Coding Alert

This guide streamlines payers diagnoses order variations.

When your FP provides a preoperative consultation, rope in pay by listing your carriers or insurers preferred primary ICD-9 code; get the order right each time by following one of three options.

Case study: An established 10-year-old patient suffering from asthma with extrinsic status asthmaticus is set to have tubes implanted to treat his chronic serous otitis media. The FP performs a consultation for the surgeon.

On the claim, youll append 493.01 (Extrinsic asthma with status asthmaticus), V72.82 (Pre-operative respiratory examination), and 381.10 (Chronic serous otitis media, simple or unspecified) to the consult code to represent the patients condition.

Problem: How should you order the ICD-9 codes?

It depends, experts say. The order of diagnoses is important in pre-op consults, says Tina Landskroener, CPC, CCS-P, PCS, business office manager for Blessing Physician Services in Quincy, Ill.

Due to differences in payer policy, however, there is no single golden rule to follow.

Option 1: List V Code 1st

Many payers, including most Medicare carriers, will want to see a V code as the primary diagnosis on your preop consults. According to the CMS transmittal ICD Coding Requirements for Preoperative Services, The ICD-9 code that appears in the line item of a preoperative examination or diagnostic test must be the code for the appropriate preoperative examination (e.g., V72.81 through V72.84).

So if your payer follows this guideline, list V72.82 as the primary diagnosis. (To read the transmittal, go to: www.cms.hhs.gov/transmittals/downloads/R1707B3.pdf.)

Option 2: Use Reason for Surgery

Other payers -- some private, some funded by Medicare -- will not accept a V code as a primary diagnosis for pre-op consults.

Some payers have instructed providers to list the patients condition necessitating the surgery as primary and to list the V code as secondary, relays Cynthia Swanson RN, CPC, senior managing consultant for Seim, Johnson, Sestak & Quist LLP in Omaha, Neb.

According to a bulletin from WPS Medicare, a Midwestern provider, If the services provided are for clearance for surgery, bill the diagnosis related to the reason for the request, or the reason for the surgical procedure. (To read the transmittal, go to: www.wpsic.com/medicare/part_b/education/em_qa.pdf.)

If your payer follows these rules, then list 381.10 as the primary diagnosis for the case study.

Option 3: Report Underlying Condition

There is also a third coding option for this scenario; some payers may want you to list the patients underlying chronic condition as the primary diagnosis.

If your payer wants the patients chronic condition first, then list 493.01 as the primary diagnosis for the case study.

Best bet: If you have any doubt as to a payers diagnosis coding preference, Landskroener recommends that you check with the carrier to minimize any consult coding confusion.