V codes identify circumstances for encounter related to circumstances other than a disease or injury and are also used to report problems or factors that may influence present or future care. Appropriate V code assignment is extremely important in terms of reporting, medical necessity and avoiding inaccurate denials. The V code chapter is a supplemental classification of ICD-9-CM and includes categories V01-V89.
Certain V codes may be used as the principal/first-listed diagnosis, others may be assigned only as additional codes and still others may be sequenced as either principal/first-listed or secondary. However, coders must be aware that sequencing guidelines/edits for V codes are different for inpatient and outpatient reporting. Official coding guidelines for reporting V codes have been incorporated into the ICD-9-CM Official Guidelines for Coding and Reporting. The V code table is included in the official coding guidelines and indicates code sequencing rules for outpatient cases, which includes physician office and clinic encounters.
For inpatient encounters, coders should ensure they are following the Medicare Code Edit (MCE) rules, particularly for Medicare cases. MCE edit #9, Unacceptable principal diagnosis, contains codes for conditions that normally would not require an inpatient level of care. In some cases, V codes are acceptable as principal diagnosis if followed by a secondary condition explaining the diagnostic reason for the encounter. The codes in category V57, Care involving the use of rehabilitation procedures, illustrate this situation. Coders should ascertain whether edits that appear in ICD-9-CM code books or software are related to inpatient or outpatient guidelines.
V Code Guidelines
Section I.C.18, "Classification of Factors Influencing Health Status and Contact with Health Service" provides guidelines for reporting V codes. There are also instructions in Sections II, III and IV on reporting V codes specifically in the inpatient and outpatient settings.
There are four major circumstances when a V code should be assigned:
1. A person who is not currently sick 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. 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. Circumstances or problems influence a person's health status but are not in themselves a current illness or injury. A patient may have a personal history of breast carcinoma or is status post coronary artery bypass grafting (CABG).
4. For newborns, to indicate birth status.
Some of the most commonly reported V code categories are presented 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. Coders should not confuse status codes with history codes, which indicate the patient no longer has the condition at all.
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. Exceptions to this general rule include categories V14, and subcategory V15.0, which indicate allergies. A person with an earlier allergic episode in the past should always be considered allergic to the substance. Family history codes are used when the family history provides additional information and medical necessity for the encounter, because family history may put the patient at higher risk for developing the same disease. 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 a serious 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 over 40, and amniocenteses are recommended for pregnant women over 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 assigned instead. The exceptions to this rule are patient encounters for V58.0, Radiotherapy, and V58.1X, Chemotherapy or Immunotherapy. If a patient receives both chemotherapy and radiation therapy during the same encounter, codes V58.0 and V58.1X may be used together with either one being sequenced first. Aftercare codes are available to identify aftercare following surgery for neoplasms and fracture care during the healing phase.
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.
To fully understand all coding guidelines related to V codes review the ICD-9-CM Official Guidelines for Coding and Reporting (Section I.C.18) and the V code tabular listing in the ICD-9-CM code book. After review, test your knowledge with the quiz below.
1. A woman with no symptoms is referred to the hospital outpatient radiology department for screening mammogram. The patient is considered high risk for breast cancer secondary to family history of breast malignancy in her 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 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 and his anticoagulant is temporarily stopped. The extractions were performed on the second hospital day and the anticoagulant 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
This month's column has been prepared by Cheryl D'Amato, RHIT, CCS, director of HIM, facility solutions, Ingenix, and Melinda Stegman, MBA, CCS, clinical technical editor, Ingenix (www.ingenix.com).
CPT is a registered trademark of the American Medical Association.
1. b. Assign code V76.11, Special screening for malignant neoplasm, Breast, Screening mammogram for high risk patient, is 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. The patient should never be given a diagnosis of a malignancy unless it is fully substantiated by the physician.
2. 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.