Part B Insider (Multispecialty) Coding Alert

Published on Tue Mar 28, 2006 PDF

The proof is in the medical necessity or patient history

If you think V codes only provide supplemental information, think again. In fact, they are key elements to successful claims. Here are two examples in which V codes can turn a potential denial into payment.

Scenario #1: A patient taking Celebrex for her arthritis and needs to have her liver and kidney functions monitored to ensure the drug isn't causing problems. The patient, who is otherwise healthy, undergoes lab tests every few months to monitor kidney and liver functions.

V code to the rescue: Report a V code that shows the patient is on a drug long-term, such as V58.64 (Long-term [current] use of non-steroidal anti-inflammatories [NSAID]), to help substantiate the need for these tests to the patient's carrier.

Why? The information V codes provide can help support a claim's medical necessity, such as a repeated lab test, says Jean Acevedo, LHRM, CPC, CHC, senior consultant with Acevedo Consulting Incorporated in Delray Beach, FL.

Scenario #2: You can also use V codes to explain follow-up testing based on the history of the disease. For instance, when the lab performs a PSA test (84153, Prostate specific antigen [PSA]; total) ordered a year after successful treatment for a prostate cancer patient, you should not use a prostate cancer diagnosis code (185, Malignant neoplasm of prostate). Instead, report V10.46 (Personal history of malignant neoplasm; prostate).

Pitfall: Acevedo often sees physicians failing to use V codes on patients whose disease process is no longer active. Mislabeling a patient as an active cancer patient could affect his ability to get health or life insurance or affect his treatment by other physicians for other conditions, Acevedo explains.

Bonus: If your lab performs Medicare screenings, here are some special screening codes you should use on your claims--and keep in your back pocket.

V76.2--... for neoplasms, cervix

V76.41--... for malignant neoplasms; other sites; rectum

V76.44--... for malignant neoplasms; prostate

V76.47--... for malignant neoplasms; vagina

V76.49--... for neoplasms; other sites (for women without a cervix)

V76.51--... for malignant neoplasms; intestine; colon

V77.1--... for diabetes mellitus

V81.0--... for ischemic heart disease

V81.1--... for hypertension

V81.2--... for other and unspecified cardiovascular conditions