Primary Care Coding Alert

Avoid denials for birth date, well check mismatches and truncated lab codes by making these changes to your ICD-9 2010 coding.

But preventing rejections isn't the only reason to start using these new codes."Even when a V code is not necessary on a claim, or with a procedure, adding these can allow your practice to monitor and track patients in a whole new way, which could very well end up increasing revenue in a most appropriate fashion," says Kris Cuddy,CPC, CIMC, of KC Medical Consulting Services in DeWitt, Mich.

You now have a tool to use to alert a patient she's past due for an immunization. In your practice, you can use V15.83 (Personal history of underimmunization status) to track patients' delinquencies or lapses in immunizations, Cuddy says. Doing so may allow a practice to establish a better form of communication with patients and allow for more timely and appropriate immunizations.

Code V15.83 can explain to an insurance carrier why an immunization may be given late, Cuddy says. Conversely, the code can advise non-compliance of patients who were previously up-to-date on their immunizations.

Don't miss: Use V15.83 as a secondary code after the code for the immunization (for instance, V03.7, Need for prophylactic vaccination and inoculation against bacterial diseases; tetanus toxoid alone). If appropriate,  for example in cases of catch-up immunization, the personal history V code may justify vaccination in an individual.

If you don't switch from your traditional preventive medicine service V code for newborn well checks, the newborn's birth date could trigger a denial for not matching the ICD-9 code's age restriction. To avoid this problem, add a pair of codes to your existing preventive medicine service V codes (V20.2, Routine infant or child health check and V70.0, Routine general medical examination at a health care facility). For a newborn exam, assign one of the following codes based on the newborn's age:

• V20.31 -- Health supervision for newborn under 8 days old

• V20.32 -- Health supervision for newborn 8 to28 days old.

"These diagnoses are provided to identify specific age ranges for newborns that need certain monitoring, such as weight checks, skin checks, etc.," says Cuddy. A child's date of birth would identify the patient's age. "Insurance carriers,however, may have an easier time tracking appropriate follow-up care by the provider, as well as parental compliance" with specific ICD-9 codes, she explains.

Codes V20.31 and V20.32 will allow your practice to track patient care by age. This could lead to developing a process of better communication with parents and more appropriate newborn care.

Get ready for three new V codes that let you better specify why a laboratory service is being ordered or performed. "The laboratory codes are long overdue and really define the purpose of the test but not the test itself," says Karen K. Byrne, RN, BS, CPC, coding analyst for Carolina Health Specialists in Myrtle Beach, S.C. The previous code, V72.6 (Laboratory examination), was no longer effective as of Oct. 1. New codes for this subcategory include:

• V72.60 -- Laboratory examination, unspecified

• V72.61 -- Antibody response examination• V72.62 -- Laboratory examination ordered as part of a routine general medical examination• V72.63 -- Pre-procedural laboratory examination• V72.69 -- Other laboratory examination.

"We anticipate using these new codes frequently," Byrne says. Medical recommendations for screening for diseases are numerous and don't have specific screening codes.

Example: A patient needs a blood test prior to a treatment or a procedure. You could use V72.63 for the lab test required prior to surgery for clearance.

Warning: Reserve V72.61 for testing a patient's immunity status. Do not use the code for allergy testing (V72.7).

Don't automatically equate V code with no money.Insurers may cover services linked to a V code. To find out if you should expect a check, follow these best practices:

1. Realize V codes are no longer always "non-payable" as they previously had been, Cuddy says. Get carrier  opinions or policies on V codes with services. You may be surprised how many V codes are payable, even as a primary diagnosis.

2. Pay attention in the ICD-9 book as to whether a V code is allowed as a primary diagnosis.

3. Read all the subsections for the V code, as they provide distinct information. For example, a note may indicate whether a second, or primary, diagnosis code is necessary.