Urology Coding Alert

Test your diagnosis coding knowledge with these 4 questions

If you think V codes are only for providing supplemental information, think again. You could be facing denials or lower payments because you're avoiding V codes. They are, in fact, key elements to correct coding practices.

Take this quiz and see how you score when it comes to the nuts and bolts of V codes. 

Question 1: True or False: You can use V codes as primary diagnosis codes.

Question 2: True or False: You should only use V codes to represent "history of" diagnoses.

Question 3: What diagnosis code should you use when a Medicare patient presents for a screening prostate-specific antigen test?

Question 4: Is your use of V codes limited by the place of service?

Compare your responses to these expert answers.
 
Answer 1: True. Many coders believe that V codes are only appropriate as secondary codes.
 
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: Certain 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.

Note: Payers may be more likely to deny claims that list a V code as the primary diagnosis on the claim, says Michael A. Granovsky, MD, CPC, FACEP, vice president of MRSI, a coding and billing company in Stoneham, Mass.

But you can't choose your codes based on payment. You should follow the official coding guidance available at www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide06.pdf.

Answer 2: False. V codes are your keys to documenting chronic conditions or underlying physical or social circumstances that can affect a patient's current health status or treatment. ICD-9 classifies V codes into four general categories:

• When a person who is not sick encounters the health services for some specific purpose, such as to act as the donor of an organ or tissue, to receive a prophylactic vaccination, to discuss a disease or injury, or to undergo a screening exam.

• When a person with a known disease or injury, whether it is current or resolving, encounters the healthcare system for a specific treatment of that disease or injury (for instance, dialysis for renal disease, chemotherapy for malignancy, cast change).

• When a circumstance or problem influences the patient's health but is not itself a current illness or injury.

• Newborns, to indicate birth status.

Answer 3: You should report V76.44 (Special screening for malignant neoplasms; other sites; prostate) per CMS guidelines for this screening benefit.

Why: For payment of HCPCS code G0103 (Prostate cancer screening; prostate specific antigen test [PSA], total), as well as HCPCS code G0102 (Prostate cancer screening; digital rectal examination), you must use the diagnostic ICD-9 code V76.44, according to CMS rules.

Answer 4: No. You can use V codes for services performed in any healthcare setting. You can use V codes in both inpatient and outpatient settings.

"I really believe reporting V codes is underutilized, especially in the outpatient setting," 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.