How to Modify a Diagnosis With a V Code
Published on Sat Jun 01, 2002
Certain V codes describe an encounter but may not be payable when used alone. But they can be combined with other diagnosis codes to give a clear picture of the overall diagnosis, including the original complaint. The combination makes the claim payable as well as accurate. This is a controversial topic, with coding experts differing on the interpretation of how to use ICD9 Codes. Use V71.x Instead of V65.5 The "worried well" diagnosis V65.5 (Person with feared complaint in whom no diagnosis was made) at first may seem appropriate for pediatrics, where the patient frequently cannot communicate verbally and the parents and pediatrician want to make sure the child is not ill. But using this diagnosis code most often results in denial. Insurance companies generally do not want to pay for a pediatrician to reassure a young mother that her infant's spitting up is normal or for a pediatrician to look in the ears of a preschooler before a family vacation merely to rule out an ear infection in the absence of any signs or symptoms. If you use V65.5 with these visits, the payer probably will deny the claim, and you will have to write it off or bill the parents. How should you handle the "worried well"? Use V71.x (Observation and evaluation for suspected conditions not found) instead, recommends Jeffrey Linzer Sr., MD, American Academy of Pediatrics (AAP) representative to the ICD-9 editorial advisory board, AAP Coding and Reimbursement Committee liaison, professor of pediatrics at Emory University, and director of emergency medicine at Children's Healthcare of Atlanta and Hughes Spalding Children's Hospital. The V71.x series of codes shows that the pediatrician was looking for a problem but did not find it.
"If you perform an examination looking for a medical condition but don't find one, use the appropriate V71 observation code instead," Linzer says. In the example of the child with recurrent ear infections but no current symptoms, use V71.89 (Observation and evaluation for suspected conditions not found; other specified suspected conditions), he says.
The otitis media example is a common dilemma for pediatricians and can be solved by some judicious questioning of the parents. If there are truly no symptoms and the parent merely wants the pediatrician to check the child's ears before a weeklong road trip, you should use V71.89. There may be a complaint that can be coded instead, however, such as ear pain (388.7x, Otalgia) or a recent cold (487.1, Influenza; with other respiratory manifestations).
If a "worried well" condition exists in a newborn (28 days or fewer), use V29.x (Observation and evaluation of newborns and infants for suspected condition not found). [...]
