Radiology Coding Alert

Question: Which ICD-9 code should I report for an extremity and central venogram screening for vein patency? The patient presented for a screening before pacemaker placement.

Georgia Subscriber

Answer: CMS and the ICD-9 official guidelines agree you should report the appropriate preoperative exam code on your claim first. In this case, that would be V72.81 (Preoperative cardiovascular examination).

But you will need to report additional codes to reflect the reason for the surgery, the reason for the test, and any findings, as well.

Official guidelines: The "ICD-9-CM Official Guidelines for Coding and Reporting," effective Oct. 1, 2008, state: "For patients receiving preoperative evaluations only, sequence first a code from category V72.8, Other specified examinations, to describe the preop consultations. Assign a code for the condition to describe the reason for the surgery as an additional diagnosis. Code also any findings related to the pre-op evaluation" (www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/ftpicd9.htm).

CMS: In 2001, Medicare issued guidelines for coding pre-op exams (CMS transmittal 1719, www.cms.hhs.gov/transmittals/downloads/R1719B3.pdf):

1. Report the pre-op V code first. "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)."

2. Then include the diagnosis that prompted surgery and the condition that prompted the pre-op eval, if any.

3. Follow these with other diagnoses and conditions affecting the patient.

Benefit: The transmittal states that preoperative diagnostic tests are payable if they are medically necessary. Medicare looks to national coverage determinations (NCDs) first to establish necessity.

If there is no NCD, you can help prove the service is reasonable and necessary by including the ICD-9 codes for the conditions that prompt the surgery and the test, the transmittal states.