Radiology Coding Alert

Question: We used to use V codes as secondary codes quite often under ICD-9 but have not caught onto their replacement series yet. Can you advise?

Codify Subscriber

Answer: Under ICD-9, you looked to the V codes as supplemental descriptions of a patient’s condition or history, and you should definitely start using their ICD-10 counterparts, the Z codes. These codes fall under the “Factors influencing health status and contact with health services” heading under the ICD-10 manual and are proving to be very important, because in many cases, they might be able to help explain why x-rays are being done, or why an interventional radiology procedure is much more complex than a typical one would be, as well as many other reasons.

The Z codes give the insurer the information it needs to pay your claim. The codes say, “I had to do this, it was important to do this, and here is why.” For instance, suppose a patient has a cough and you’re performing a chest x-ray for it. The payer may not reimburse the chest x-ray for a simple cough, but if the patient has a history of lung cancer, report that history code (Z85.110, Personal history of malignant carcinoid tumor of bronchus and lung), which helps you justify the medical necessity for the x-ray.

In another example, a patient presents for an ultrasound because she is getting a breast implant removed and the surgeon wants a report on whether it’s intact before performing the procedure. In this case, your best code would be Z45.81 (Encounter for adjustment or removal of breast implant).