Wiki V70.0 and V58.69 use

[cmoon]

I have 2 providers who have started to use V70.0 and V58.69 extensively. For example, a routine visit for f/u on HTN and DM they will code 401.9, 250.00, V70.0 and V58.69. They will usually make a comment about something related to health maintenance (due for colonoscopy, needs mammo, etc.) but I'm not comfortable just slapping V70.0 on every claim. Also, their use of V58.69. Should that be used at every visit where they refill meds or just for high risk meds?

 

[OCD_coder]

I would be leary about using a V70.0 on a sick visit CPT coded (99201-992015), this Dx code is used with preventative type of codes. If they are just reminding a patient of a routine test (mammo, colonoscopy), I would review documentation for medical necessity vs incidental to the visit type of scenarios. The V70.0 is a first listed code by HCPCS guidelines, this will cause the claim to deny by most carriers.

A high-risk medication is a medication that requires some sort of monitoring either with labs or another diagnostic as to the effects on other organ systems; this is not an exclusive thought process here. We use V58.69 for INR checks I can't see why we could potentially also use if for A1C checks also. I am open to others opinions here.

For example, IV insulin is considered high-risk and has a high incidence of toxicity to other organ systems. But oral diabetic meds are monitored for thier therapeutic effect with say an A1C lab. So I am not sure the V58.69 would be indicated without reviewing the documentation.

Your instincts are good, this is an excellent question.

 

[erjones147]

I always drop V70.0 for a sick visit (even a follow-up), and the only times I use V58.69 are for certain pharmacy refills (our clinic has an in-house pharmacy) or if an outside provider ordering labs uses it on the lab order

 

[mitchellde]

for a pt encounter to review the meds and order labs use the V58.83 first listed for therapeutic drug monitoring along with the V58.6- code.

 

[cmoon]

Thank you!