Pathology/Lab Coding Alert

Use ICD-9 changes to confirm reason for lab tests If you're looking for a better way to specify why you're performing a lab test for patients with no current signs or symptoms of disease, you'll soon have some new tools at your disposal.

Thanks to new ICD9 Codes that go into effect Oct. 1, additional V codes will help you show medical necessity when a physician orders lab procedures for genetic testing, egg donation, blood typing, or based on history of disease. You Can Show Medical Necessity With V Codes When you perform a procedure for circumstances other than a disease or condition that you can classify with ICD-9 codes 001-999, you may need a V code to explain the situation, says Laurie Castillo, CPC, CPC-H, CCS-P, owner of Castillo Consulting in Manassas, Va.

Medicare and other payers may accept V codes to show medical necessity for certain lab procedures. "Sometimes a V code alone establishes the reason for the procedure, but sometimes you should use the V code as a secondary diagnosis," Castillo says.

Example: A physician may use new ICD-9 code V72.86 for blood typing encounters to order Rh phenotyping (86906, Blood typing; Rh phenotyping, complete) for a father to help assess the possibility of Rh incompatibility and hemolytic disease of newborn. Choose Specific 'History of' Codes Starting Oct. 1, ICD-9 lists eight new codes for personal or family history of disease, which you can see in the following table. By adding some specific five-digit codes for history of different respiratory conditions and musculoskeletal disease, ICD-9 also eliminates the four-digit codes V12.6 and V17.8 that you now use to report these circumstances. "You'll have to start using the appropriate five-digit code on Oct. 1," Castillo says.

ICD-9 also adds new codes V13.02 and V13.03 under existing subcategory code V13.0x (Personal history of disorders of the urinary system), which requires a fifth digit. The code set also adds V18.9 for history of genetic disease carrier under category V18.x (Family history of certain other specific conditions). "The physician may use this code to order testing to see if a patient carries the gene for a specific disease when family members are known carriers," Castillo says.  Egg Donor Codes Explain Reproductive Procedures The lab may perform certain procedures such as isolating eggs (89254, Oocyte identification from follicular fluid) and storing them (89346, Storage [per year]; oocyte[s]) when a patient donates eggs. "New codes V59.70-V59.74 provide a way to link the egg donation and the lab procedures for processing the eggs," Castillo says.  Describe Prenatal Tests With V Codes When a physician orders genetic testing to help patients understand their risk of passing on inherited disease, two new ICD-9 codes help the physician describe [...]