Anesthesia Coding Alert

These steps help you hunt down reimbursement making V codes.

Are you avoiding ICD-9s V code section because you dont think it applies to your claims -- or using back pain because you think the diagnosis supports an epidural? Think again.

To stop omitting info that can help get a claim paid, or making common entry mistakes that can sink payment chances, try these tips.

Follow Subterms to the Best Diagnosis

Check out the following example of when V codes can help your claims, courtesy of Emma LeGrand, CPC,CCS, coding supervisor for New Jersey Anesthesia/Health Network Management in Florham Park.

Lets assume you have a patient for prophylactic organ removal of an ovary. To get to the diagnosis code, you have several steps to take:

1. Search for the term Admission in the ICD-9 index.

2. Beneath the term Admission, reference the subterm for.

3. Follow your choices to the subterm prophylactic.

4. Beneath prophylactic, look for organ removal.

5. Under organ removal, end at ovary, which designates code V50.42.

6. Look up V50.42 in ICD-9s tabular section, which gives you Prophylactic organ removal; ovary. Check the entry for additional instructions or coding guidelines.

The surgeon and anesthesiologist can each submit their claims with V50.42 as the primary diagnosis and V16.41 (Family history of malignant neoplasm; ovary) as the secondary diagnosis if the patients background includes such history.

Coders do not have to restrict themselves from using V codes, LeGrand says. V codes provide additional information and specificity, which helps your coding and can help get your claims paid.

Caution: Carrier guidelines can differ on insurers use or acceptance of certain V codes, so check your payers policies before submitting claims.

LeGrand also recommends periodically reviewing the ICD-9-CM Official Guidelines for Coding and Reporting (visit www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide08.pdf). Its always good to review the basics from time to time, she says.

Watch for Mismatched Diagnoses Subtleties

Reporting the correct diagnosis for a procedure is just as important as correctly coding the procedure. Some procedures have a list of approved diagnoses, says Jann Lienhard, CPC, a coder in New Jersey. If the payer doesnt agree that your reported diagnosis supports the procedures medical necessity, the payer could deny your claim.

In your coding, watch out for these common diagnosis mistakes:

" Not updating a pain management patients diagnosis -- for example, administering an epidural with a vague diagnosis such as back pain

" Due to lack of provider documentation, reporting an unspecified spinal region diagnosis code -- for example,721.90 (Spondylosis of unspecified site; without mention of myelopathy)

" An incorrect diagnosis for post-op pain management.

Many payers have specific guidelines for the diagnoses they consider acceptable for postoperative pain management.

Example: A payer may list only three diagnoses to justify 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) and epidural codes 62310-62319. The payer may accept 338.11 (Acute pain due to trauma), 338.12 (Acute postthoracotomy pain), and 338.18 (Other acute postoperative pain). Tip: Always verify your payers post-op pain management policy .

Check Your Spelling

Some mistakes can be a simple matter of keying the wrong diagnosis, Lienhard says. If you receive a diagnosis-based denial, verify that you didnt submit a claim with a typo.

If the diagnosis you submitted was correct but isnt on the payers list, talk with your physician. A secondary diagnosis he documented might work just as well.