V codes identify circumstances when a patient presents with issues other than a disease or injury. V codes are also used to report problems or factors that may influence care. The V code chapter is a supplemental classification of ICD-9-CM and includes codes V01-V82. Certain V codes may be used as the principal or first listed diagnosis and others may be used only as additional codes. Since 1996 AHA's Coding Clinic has included an annual update article on the use of V codes in its Fourth Quarter issue. Recently coding guidelines for reporting V codes have been incorporated into the ICD-9-CM Official Guidelines for Coding and Reporting. From year to year any pertinent changes to the V codes will be included in the official coding guidelines and in Coding Clinic. V codes may be used in all health care settings for both inpatient or outpatient services unless the coding guidelines specifically indicate otherwise. There are some differences in the V codes that may be used as the principal and secondary diagnosis in the inpatient setting compared to those that may be used as the first listed or secondary diagnosis in the outpatient setting. The V code table, which is now included in the official coding guidelines, is included in our Web site copy of this article.
V Code Coding Guidelines
Section I of the coding guidelines includes a new section C18 "Classification of Factors Influencing Health Status and Contact with Health Service." This section provides coding guidelines for reporting V codes. There are also instructions in Sections II, III and IV on reporting V codes.
There are four main circumstances when a V code should be used:
1. When a person who is not currently sick and presents for another reason, such as to act as an organ donor, to receive prophylactic care or to receive counseling on health-related issues.
2. When a person with a resolving or chronic disease, injury or condition presents for aftercare of that disease or injury such as dialysis for renal disease; chemotherapy for malignancy; or a cast change.
3. When circumstances or problems influence a person's health status but are not in themselves a current illness or injury.
4. For newborns, to indicate birth status.
V codes fall into a number of major categories including:
Contact/ExposureExposure to smallpox V01.3
Inoculations and vaccinations-Encounter for Flu vaccine V04.81
Status-Asymptomatic HIV status V08
Family or personal history (of)-Personal history breast cancer V10.3
Screening-Glaucoma screening V80.1
Observation-Observation for suspected anthrax exposure - V71.82
Aftercare or Follow-up-Encounter for removal internal fixation device V54.01
Donor-Kidney donor V59.4
Counseling-HIV counseling V65.44
Obstetrics and related conditions-Routine postpartum follow-up V24.2
Newborn, infant and child-Twin newborn, born in hospital V31.0
A number of the coding guidelines related to V Codes are included below.
Status: Status codes indicate that a patient is either a carrier of a disease or has the sequelae or residual of a past disease or condition. A status code is important because the status may affect the treatment plan and its outcome. Status codes can also be used to track public health issues. For example, the code for asymptomatic HIV status is assigned for patients who are HIV positive but are asymptomatic and have no history of an HIV related condition. There are status codes for a number of other circumstances including carrier or suspected carrier of infectious disease, amputation status and long-term (current) drug use.
History (of): There are two types of history V codes, personal and family. Personal history codes indicate a personal history of a previous illness or condition. If a condition is still present or if the patient is still under treatment for the condition a history code is not reported. The exceptions to this general rule are category V14, Personal history of allergy to medicinal agents and subcategory V15.0, Allergy, other than to medicinal agents. A person who has had an allergic episode to a substance or food in the past should always be considered allergic to the substance. Family history codes are used when the family history is the reason for the encounter. For example, a patient presents for a colonoscopy because of a family history of colon cancer.
Family history codes may be used with screening codes to support the need for a screening test or procedure. History codes support the need for mammograms and colon cancer screenings. History codes may be used in any setting regardless of the reason for visit. A history of an illness, even if no longer present, is important information that may alter the type of treatment ordered.
Screening: Screening is the testing for diseases in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease. Among others, screening mammograms are recommended for women older than 40, and amniocenteses are recommended for pregnant women older than 35 to rule out a fetal anomaly. If testing is performed because the patient has a sign or symptom, the sign or symptom code is used to explain the reason for the test, not the screening code.
A screening code may be a first listed code if the reason for the visit is specifically the screening exam. It may also be used as an additional code if the screening is done during an office visit for other health problems. If a condition is discovered during the screening then the code for the condition may be assigned as an additional diagnosis.
Aftercare: Aftercare visit codes are used when the initial treatment of a disease or injury has been completed but the patient requires continued care during the healing phase, or for the long-term consequences of the disease. The aftercare V code should not be used if treatment is directed at a current disease or injury. The diagnosis code is to be used instead. The exceptions to this rule are patient encounters for V58.0, Radiotherapy, and V58.1, Chemotherapy. If a patient receives both chemotherapy and radiation therapy during the same encounter codes V58.0 and V58.1 may be used together with either one being sequenced first. There are a number of aftercare codes in addition to those for chemotherapy or radiation therapy. These include codes to identify aftercare following surgery for neoplasms and fracture care during the healing phase.
There is some confusion on how to code fractures in the healing phase. The fracture codes from the main classification can only be used for the initial encounter. Coding guidelines require that the aftercare V codes be used for all subsequent encounters. Subcategories 54.1, aftercare for healing traumatic fracture and V54.2, aftercare for healing pathologic fracture have been created to identify the fracture site being treated. If a patient is seen at home by a home care provider after being treated elsewhere for a fracture then a code from the V54.1 or V54.2 category is assigned.
Aftercare codes are generally listed first to explain the reason for the encounter. An aftercare code may also be used as an additional code when aftercare is provided for reasons other than reason for admission. An example of this would be the closure of a colostomy during an encounter for treatment of another condition.
Routine and administrative examinations: V codes allow for the description of encounters for routine examinations, such as a general check-up, or examinations for administrative purposes, such as a pre-employment physical. The codes are listed first only and are not to be used if the examination is for diagnosis of a suspected condition or for treatment purposes. If a diagnosis or condition is discovered during a routine exam it should be coded as an additional code. Pre-existing and chronic conditions and history codes may also be included as additional codes as long as the examination is for administrative purposes and not focused on any particular condition.
Pre-operative examination V codes are used only in those situations when a patient is being cleared for surgery and no treatment is given.
To fully understand all coding guidelines related to V codes review the ICD-9-CM Official Guidelines for Coding and Reporting (Section C.18) and the V code tabular listing in the ICD-9-CM code book. After reviewing the official coding guidelines and the article on the Use of V Codes in Coding Clinic Fourth Quarter 2003, test your knowledge with the quiz below.
1. A woman with no symptoms is referred to the hospital outpatient X-ray department for screening mammogram. The patient is considered high risk for breast cancer secondary to family history of breast malignancy in the mother and sister. How should the diagnoses for this case be coded?
a. V16.3, V76.11
b. V76.11, V16.3
c. V76.12, V16.3
2. A patient is admitted for observation of possible brain injury following a collision with another automobile while driving home from work. The patient also had minor bruises to the upper back and abrasions to the arm. An antibiotic ointment was applied to the abrasions. Brain injury was ruled out. How should the diagnoses for this case be coded?
a. V71.4, 922.31, 913.0, E812.0
b. 922.31, 913.0, E812.0
c. 959.01, 922.31, 913.0, E812.0
3. A patient is admitted for removal of retained myringotomy tube. How should the diagnoses for this case be coded?
b. V58.49, 385.83
4. A patient with a history of mitral valve repair, aortic valve replacement and bypass surgery is admitted for dental extractions because of dental caries. The patient is admitted prior to the scheduled dental procedure to stop his anticoagulant. The extractions were performed on the second hospital day and antigoagulant was restarted on the fourth day. How should the diagnoses for this case be coded?
a. V58.61, 521.00, V58.83, V43.3, V45.81
b. V58.83, 521.00, V58.61, V43.3, V45.81
c. 521.00, V58.83, V58.61, V43.3, V45.81
5. A patient is seen in the outpatient clinic for colonoscopy due to family history of colon cancer. The patient has no personal history of gastrointestinal disease and is currently without signs and symptoms. The colonoscopy revealed a colonic polyp. How should the diagnoses for this case be coded?
a. V76.51, V16.0, 211.3
b. 211.3, V76.51, V16.0
c. V16.0, 211.3, V76.51 n
This month's column has been prepared by Cheryl D'Amato, RHIT, CCS, director of HIM, and Melinda Stegman, MBA, CCS, manager of clinical HIM services, HSS Inc. (www.hssweb.com), which specializes in the development and use of software and e-commerce solutions for managing coding, reimbursement, compliance and denial management in the health care marketplace.
Coding Clinic is published quarterly by the American Hospital Association.
CPT is a registered trademark of the American Medical Association.
Answers to CCS PREP!:
1. b. Assign code V76.11, Special screening for malignant neoplasm, Breast, Screening mammogram for high risk patient, as the first-listed diagnosis, followed by code V16.3, Family history of malignant neoplasm, Breast. High risk factors include a family history of breast cancer; 2. a. When a patient is admitted for observation for a possible serious injury, in this case a brain injury, V71.4 is assigned as the principal diagnosis even though other minor injuries are present. The minor injuries would not have required hospitalization. Other codes assigned are 922.31 and 913.0 to identify the abrasions and contusions. E812.0 is assigned for the automobile accident as the cause of the injury; 3. c. Because there is no documentation that otitis media or accumulation of fluid in the eustachian tube is present and the patient is returning for removal of the myringotomy tube, code V58.49, Other specified aftercare following surgery is assigned; 4. c. The admission was for the dental surgery and management of anticoagulant therapy was needed in preparation of the surgery. Because the reason for the admission was for the dental extractions, assign the dental caries as the principal diagnosis. Assign codes for V58.61, Long-term (current) use of anticoagulants, V58.83, Encounter for therapeutic drug monitoring, V43.3, Organ or tissue replaced by other means, Heart valve, and V45.81, Aortocoronary bypass status as additional diagnoses; 5. a. Assign code V76.51, Special screening for malignant neoplasms, colon, as the first-listed diagnosis because this was a screening colonoscopy. Code V16.0, Family history of malignant neoplasm, gastrointestinal tract, may be assigned as an additional diagnosis. Assign code 211.3, Benign neoplasm of colon as an additional diagnosis.