Part B Insider (Multispecialty) Coding Alert

Published on Fri Jan 04, 2013 PDF

V Codes can help you in this scenario, but like all ICD-9 codes, they don’t guarantee payment.

Question: A 78-year-old established Medicare patient reports to the office for a visit stemming from a recent auto accident he was in; he collided with another car at low speed while driving. The patient reports no outward symptoms, but "wanted to get checked out just to be safe." A qualified nonphysician practitioner (NPP) performs a problem-focused history and exam, but finds nothing wrong with the patient. How should I code for this service, being that there is no clear diagnosis?

Answer: There’s a V code that may help you prove medical necessity for this visit. On the claim, report the following:

• 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making …) for the E/M,

• V71.4 (Observation and evaluation for suspected conditions not found; observation following other accident) appended to 99212 to represent the reason for the visit, and

• E812.0 (Other motor vehicle traffic accident involving collision with motor vehicle; driver of motor vehicle other than motorcycle) also appended to 99212 to represent the type of accident that occurred.

Exception: The above coding assumes that the patient was not driving for his employer when the accident occurred. If the patient had the accident on the job, report V71.3 (… observation following accident at work) instead of V71.4. Being that this was a Medicare patient, you’ll probably stick with V71.4.

Your payer will evaluate the medical necessity of the claim like any other, so there is no guarantee you will be able to collect for the visit, but the V code is correct coding in this scenario nonetheless.

Remember to report this visit under the NPP’s National Provider Identifier (NPI). Because she was treating the patient for a new problem, you cannot bill incident-to the physician.