Pulmonology Coding Alert

Our experts show you the codes you can report as primary diagnoses

If you think that you can only report ICD-9 V codes as secondary diagnosis codes, you'll want to reconsider. There are times when you should use V codes as the primary diagnosis code to get the most for your pulmonologist's services.

Learn the Purpose of a V Code

You should use V codes to provide additional clinical information to an insurer, whether it's Medicare or a private carrier. "V codes do not really increase your payments per se," says Mary Mulholland, BSN, RN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvania's department of medicine in Philadelphia. "When you submit claims for clinical services, the diagnosis codes reported paint a clinical picture of the patient's condition(s)."

The person reviewing your claim for Medicare or the private carrier does not have your pulmonologist's progress note in front of him. By reporting V codes, you're providing additional accurate information that will make the claim easier to process.
You can use V codes in both inpatient and outpatient settings, and as either a primary diagnosis code or a secondary, supportive diagnosis code. "I really believe reporting V codes is underutilized, especially in the outpatient setting," Mulholland says.

If a V Code Is the Best Option, Use It

Most coders believe that V codes are only appropriate as secondary codes. "I think the perception with V codes is that insurances do not pay on them or if a coder uses them, they will get denied and that will require them to submit office/op reports to get the claim paid," says Becky Stanaland, CCS-P, of SS&G Healthcare LLC in Akron, Ohio.

Reality: Contrary to what you might have been told in the past, you may--and, on occasion, should--report V codes as a primary diagnosis.
 
Tip: Many versions of the ICD-9 manual will indicate if you may report a V code as a primary or secondary diagnosis code with the indicators "PDx" (primary) and "SDx" (secondary) next to the code descriptor. If the code has neither a "PDx" nor an "SDx" designation, you may use that V code as either a primary or secondary diagnosis code, according to ICD-9 instructions.

Use V42.6 for Post-Transplant Patients

Perhaps the most common instance when you should select a V code as a primary diagnosis is for a post-lung transplant patient. "Lung transplant groups use V42.6 every day they see patients," says Alan L. Plummer, MD, professor of medicine, division of pulmonary, allergy, and critical care at Emory University School of Medicine in Atlanta. For post-transplant patients, you should report V42.6 (Lung transplant) as the primary diagnosis code.
 
Example: A patient who has had a lung transplant comes into your office for a follow-up care appointment. You should report the routine office visit using 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components ...). You'll use V42.6 as the primary diagnosis code. You don't have to report additional, secondary diagnosis codes in this case, Mulholland says, since the reason for the office visit is follow-up on the patient's lung transplant.

Consider These Other V Codes

Another common use for primary-diagnosis V codes is when your pulmonologist sees a patient solely for a flu shot or pneumovax. When your physician sees a patient for a flu shot, use V04.81 (Influenza). For pneumovax administration, you should report V03.82 (Streptococcus pneumoniae). Some private insurers may require you to use additional codes with the V code when immunizing the patient. If the patient has a condition that places him at greater risk for developing the flu or pneumonia (e.g., asthma, 493.90), you may report the code representing the condition secondary to the V code.

V codes may also be the most appropriate primary diagnosis code when your pulmonologist performs a pre-operative examination on a patient who is going to undergo surgery unrelated to his pulmonary condition. Most surgeons won't put a patient with a pulmonary condition under anesthesia for surgery unless a pulmonologist sees him first, Mulholland says. A V code is appropriate for the primary diagnosis in this situation, she adds.
 
Example: Your pulmonologist performs a pre-operative examination and consultation for a patient with COPD and degenerative joint disease prior to her surgery for hip replacement. The surgeon asks the pulmonologist to clear the patient for surgery and to give his recommendations for preoperative, intraoperative, and postoperative pulmonary care. In this case, you can report V72.82 (Pre-operative respiratory examination) as the primary reason for the consultation because that is the reason that the pulmonologist is really seeing the patient.
 
Then, report the comorbid condition(s) requiring clearance by the pulmonologist, such as 496 (Chronic obstructive pulmonary disease NOS) in this case. You should also add the reason for the surgery, 715.9x (Osteoarthrosis, unspecified whether generalized or localized) in this example.

Watch for more information on V codes in an upcoming issue of Pulmonology Coding Alert.