Wiki Icd-9 post operative code

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mitzfritz215

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I was asked for a diagnosis code for post operative cholescystectomy visit at D.C., P.A. physicians office. Is there a postoperative V code? I see there is preoperative V codes and only V67.00 code for following surgery. I've only been coding for 1 1/2 months with no mentor at this office. Trying to do it on my own. Need a lot of help please. Thanks
 
mitzfritz215 said:
I was asked for a diagnosis code for post operative cholescystectomy visit at D.C., P.A. physicians office. Is there a postoperative V code? I see there is preoperative V codes and only V67.00 code for following surgery. I've only been coding for 1 1/2 months with no mentor at this office. Trying to do it on my own. Need a lot of help please. Thanks
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I think you're thinking of aftercare codes, like V58.75 (aftercare following surgery on the digestive system) - it's for care after the surgery, but while the patient is still healing. ;)
 
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Dx code

I would say the visit is part of the surgery global period and wouldn't be billed unless there is some complication necessitating the visit.
 
Dx code

Following on to my previous reply, I was assuming it was the same doc who did the surgery that was seeing the patient or was it the patients PCP? If so, I guess the V code suggested previously would be the only one applicable... you could also add V45.79 for acquired absence of other organ to more accurately describe the situation (I don't have access to a current ICD-9 at home so not sure if there is a specific V code for gallbladder).
 
wassock said:
Following on to my previous reply, I was assuming it was the same doc who did the surgery that was seeing the patient or was it the patients PCP? If so, I guess the V code suggested previously would be the only one applicable... you could also add V45.79 for acquired absence of other organ to more accurately describe the situation (I don't have access to a current ICD-9 at home so not sure if there is a specific V code for gallbladder).
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I think V45.79 is a good secondary code to V56.75- I didn't see that one before. ICD-9 guidelines state to make the first-listed diagnosis the one that best describes the reason for the encounter shown in the record to be chiefly responsible for the services rendered. Also, it says that aftercare codes should be listed first, followed by codes that describe the surgery in more detail - the one you mentioned seems to jive with the example they have listed. It's all under Section I, 7: Aftercare, if you decide to look it up when you get around your book.

You're right that there's no specific code for gallbladder...I need to clarify something about my previous V-code suggestion, though - Depending on what the note says...

V58.75 would be used if the patient hadn't completely healed from their surgery, but if the patient had completely healed by their checkup (I know I was when I had mine out - it was laproscopic), it wouldn't be considered "aftercare" anymore - it would be "follow up" - the closest one I could find was V67.09. I don't believe you would use a secondary code with V67.09, but I could be mistaken.

It's good that you pointed out the circumstances of when post-op care wouldn't be billable -those CPT guidelines are important to keep in mind when coding post-surgical encounters; but ICD-9 selection should be accurate, whether the service is billed or not, in case it needs to be reported for any other purposes. Have a good weekend! ;)
 
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