The patient presents post surgical Spinal Fusion, along with hip pain jaw pain, leg pain, and low back pain. I believe I am unable to bill with the V-code as a primary code for the spinal fusion. The v-code is a Medicare Exempt code ( for Physical Therapy). Can someone please clarify if I can bill the V-code and still receive Medicare Exempt status for the Therapy cap?
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Wiki V- Code as Primary
- Thread starter Imelda24
- Start date
mitchellde
True Blue
If you are seeing this patient for rehab then the code is V57.1 it is required first listed and is first listed only allowable.
It would help to know the reason for the encounter.
You must use the dx code that fits the documentation for the encounter.
It would help to know the reason for the encounter.
You must use the dx code that fits the documentation for the encounter.
The patient is coming in because she has pain. We are a physical Therapy clinic so all patients are coming in for rehab. The Diagnosis the script the physician provided is post op spinal fusion, jaw pain, leg pain, hip pain, and low back pain. I want to know if I can bill with the V- code as a secondary code ( as I think they can not be billed primary) and still have medicare exempt status?
mitchellde
True Blue
If your patients are coming for rehab you are required to use the V57.1 as the first listed code the secondary code is the reason for rehab. V57.1 can never be a secondary code, it is designated as first listed only. Per coding guidelines :
on the first page:
Adherence to these guidelines when assigning ICD-9-CM diagnosis and procedure codes is required under the Health Insurance Portability and Accountability Act (HIPAA). The diagnosis codes (Volumes 1-2) have been adopted under HIPAA for all healthcare settings. Volume 3 procedure codes have been adopted for inpatient procedures reported by hospitals.
on page 12:
15. Admissions/Encounters for Rehabilitation
When the purpose for the admission/encounter is rehabilitation, sequence the appropriate V code from category V57, Care involving use of rehabilitation procedures, as the principal/first-listed diagnosis. The code for the condition for which the service is being performed should be reported as an additional diagnosis.
Only one code from category V57 is required. Code V57.89, Other specified rehabilitation procedures, should be assigned if more than one type of rehabilitation is performed during a single encounter. A procedure code should be reported to identify each type of rehabilitation therapy actually performed.
on the first page:
Adherence to these guidelines when assigning ICD-9-CM diagnosis and procedure codes is required under the Health Insurance Portability and Accountability Act (HIPAA). The diagnosis codes (Volumes 1-2) have been adopted under HIPAA for all healthcare settings. Volume 3 procedure codes have been adopted for inpatient procedures reported by hospitals.
on page 12:
15. Admissions/Encounters for Rehabilitation
When the purpose for the admission/encounter is rehabilitation, sequence the appropriate V code from category V57, Care involving use of rehabilitation procedures, as the principal/first-listed diagnosis. The code for the condition for which the service is being performed should be reported as an additional diagnosis.
Only one code from category V57 is required. Code V57.89, Other specified rehabilitation procedures, should be assigned if more than one type of rehabilitation is performed during a single encounter. A procedure code should be reported to identify each type of rehabilitation therapy actually performed.
The V-code I am referring to is v45.4 for post op spinal fusion and then I have all the pain codes 719.45, 729.5, 724.2, and 526.9.
I am wanting to know if I can bill v45.4 as the primary or if I bill it as the secondary will the patient still be exempt from the medicare cap?
I am wanting to know if I can bill v45.4 as the primary or if I bill it as the secondary will the patient still be exempt from the medicare cap?
mitchellde
True Blue
V45 codes are secondary codes. But if this is a rehab encounter what I am saying is your first listed code will be a V code, it will be V57.1 The patient may not be exempt when using this code, but it is the correct code to use for all rehab encounters.
OCD_coder
True Blue
I agree with Debra, V57.1 encounter is specifically describing the intent/purpose of the visit is for rehab is specifically a primary code. The V45.4 Arthrodesis is describing the status of the patient, not the reason for the encounter. The signs or symptoms the patient is having outside of what would be expected for the fusion, possibly the jaw pain could be listed between the two ICD-9 codes.
When I mentor coders I have them wite in their books: Status codes are always last on the claim.
We bill with this code combination in this order and have had great success with reimbursement.
When I mentor coders I have them wite in their books: Status codes are always last on the claim.
We bill with this code combination in this order and have had great success with reimbursement.