Optometry Coding & Billing Alert

Published on Wed Apr 25, 2007 PDF

Test your diagnosis coding knowledge with these questions

If you think V codes are only for providing supplemental information, think again. You could be facing denials or lower payments because you avoid using V codes on your claims.

V codes are, in fact, key elements to correct coding practices. Take this quiz and see how you score when it comes to the nuts and bolts of V codes.

Question 1: True or False: You can use V codes as primary diagnosis codes.

Question 2: True or False: You should only use V codes to represent -history of- diagnoses.

Question 3: What diagnosis code should you use when a primary-care physician sends a patient who is now taking Plaquenil to your optometry office for monitoring possible ocular changes?

Question 4: Is your use of V codes limited by the place of service?

Quick Quiz Answers:

Answer 1: True. Many coders believe that V codes are only appropriate as secondary codes.

Reality: Contrary to what you might have been told in the past, you may--and, on occasion, should--report V codes as a primary diagnosis.

Tip: Many versions of the ICD-9 manual will indicate if you may report a V code as a primary or secondary diagnosis code with the indicators -PDx- (primary) and -SDx- (secondary) next to the code descriptor. If the code has neither a -PDx- nor an -SDx- designation, you may use that V code as either a primary or secondary diagnosis code, according to ICD-9 instructions.

Note: Payers may be more likely to deny claims that list a V code as the primary diagnosis on the claim, says Michael A. Granovsky, MD, CPC, FACEP, vice president of MRSI, a coding and billing company in Woburn, Mass.

But you can't choose your codes based on payment. You should follow the official coding guidance at www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide06.pdf.

Answer 2: False. V codes are your keys to documenting chronic conditions or underlying physical or social circumstances that can affect a patient's current health status or treatment. ICD-9 classifies V codes into four general categories:

- When a person who is not sick encounters the health services for some specific purpose, such as to act as the donor of an organ or tissue, to receive a prophylactic vaccination, to discuss a disease or injury, or to undergo a screening exam.

- When a person with a known disease or injury, whether it is current or resolving, encounters the healthcare system for a specific treatment of that disease or injury (for instance, dialysis for renal disease, chemotherapy for malignancy, cast change).

- When a circumstance or problem influences the patient's health but is not itself a current illness or injury.

- Newborns, to indicate birth status.

Answer 3: You should report V58.69 (Long-term [current] use of other medications) as your primary diagnosis code.

Why: When a primary-care physician sends a patient to your optometrist to check for ocular changes caused by the drug Plaquenil, the diagnosis code you choose depends on whether the patient is now taking Plaquenil.

If the patient has not yet started taking Plaquenil, use the diagnosis code for the condition for which the patient will be taking the Plaquenil (e.g., malaria, lupus erythematous, rheumatoid arthritis) as your primary and only diagnosis. Many optometrists use this as a baseline visit in order to better assess and detect any ocular changes once the patient begins taking the high-risk medication. 

After the patient starts taking the drug and the optometrist sees him for follow-up evaluation, report V58.69 as your primary diagnosis. Use the diagnosis code for which the patient is taking the Plaquenil as your secondary diagnosis code.

However, if the optometrist finds changes, use the changes as the primary diagnosis and use V58.69 as the secondary diagnosis, followed by the condition for which the patient is taking the Plaquenil as the third diagnosis.

Once the patient has completed treatment with the Plaquenil, for the follow-up visit report V67.51 (Follow-up examination; following completed treatment with high-risk medications, not elsewhere classified) as your primary diagnosis. Again, if the optometrist finds ocular changes, list the changes as your primary diagnosis, followed with V58.69 as your secondary diagnosis.

Additional info: Plaquenil is the trade name for hydroxychloroquine, a medication used to treat rheumatoid arthritis and lupus. The drug can harm the lens and retina of the eye. Primary-care physicians often refer a patient to an optometrist to perform visual fields (92081-92083, Visual field examination, unilateral or bilateral, with interpretation and report ...) for monitoring possible ocular changes.

Answer 4: No. You can use V codes for services performed in any healthcare setting. You can use V codes in both inpatient and outpatient settings.

-I really believe reporting V codes is underutilized, especially in the outpatient setting,- says Mary Mulholland, BSN, RN, CPC, reimbursement analyst for the office of clinical documentation at the University of Pennsylvania's department of medicine in Philadelphia.