Oncology & Hematology Coding Alert

Question: When is it appropriate to use V67.1? We have been told to use it when a patient comes in for a followup exam after radiation treatment and to use it once treatment is complete. Which is correct?

Colorado Subscriber

Answer: ICD-9 states that V67.1 (follow-up examination, following radiotherapy) is for surveillance only after radiation therapy has been finished. Other codes are more appropriate before the course of radiation therapy has been completed.

For example, V58.0 (encounter or admission for radiotherapy) is appropriate, but several definitions accompany it because there are various ways a diagnosis may be stated between geographic localities. The definitions for V58.0 are aftercare radiotherapy; radiotherapy admission for intracavity irradiation implant rectum; radiotherapy encounter; radiotherapy maintenance; and radiotherapy session. V58.1 can also be used for radiotherapy admission. All of these codes are more appropriate to use for the course of radiation therapy.

There is, however, a larger question of whether a V code should be accompanied by another diagnosis code and serve as a secondary diagnosis code.

Texas Medicare, for example, will not commit to whether the code will stand alone as the primary diagnosis code, nor has it published a list of those V codes that can stand alone as primary.

Despite this, Medicare tends to prefer that V codes be used as supporting codes only. The Coders Desk Reference advises that V codes describe circumstances that influence a patients health status and identify reasons for medical encounters resulting from circumstances other than a disease or injury classified in the pain part of ICD-9. V codes are generally used when:

1. a physician identifies a circumstance or problem in a person who is not now sick but has come in contact with health services (to act as an organ donor or to receive a prophylactic vaccination, for example);

2. an ill or injured patient requires specific treatment (such as chemotherapy for malignancy or removal of pins or rods in postoperative orthopedic care); or

3. a problem or circumstance that influences the patients health is not a current illness but may affect future treatment.

V codes are diagnosis codes used to provide supplemental information to primary diagnosis codes and define the context of the encounter. They may establish medical necessity, which may increase reimbursement. Experts agree that they are usually used as the second or third diagnosis.

They should be thought of as status descriptors, such as personal history of ... ; family history of ... ; suspected condition of ... ; etc. As a rule, the main problem responsible for the diagnostic or therapeutic service rendered is sequenced as the primary diagnosis. Codes for additional problems affecting treatment may be added.

It seems that what Medicare requires and other insurance companies will accept are different. The ultimate decision should lie with the carrier.

This question was answered by Lillie McCalister, CPC, president of Double-Diamond Enterprises, a coding and billing consulting firm in Conroe, Texas.