Primary Care Coding Alert

Surprise:  Steer clear of V70.0 for more specific diagnoses, expert say

Despite CMS- lack of ICD-9 coding directive on the initial preventive physical exam (IPPE) and related screening electrocardiogram (ECG), these steps will ensure diagnosis coding that will keep your claims moving and the reimbursement flowing.

Step 1: Use V70.5 With the IPPE

Experts suggest that you link diagnosis V70.5 (Health examination of defined subpopulations)--rather than the less specific V70.0--to IPPE (G0344, Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first six months of Medicare enrollment).
 
-I do not support use of ICD-9-CM diagnostic code V70.0,- says John L. Inase, BA, RHIT, CPC, CTR, health information specialist and coding auditor at the Naval Medical Center in San Diego. The IPPE is not a routine health checkup as V70.0's descriptor indicates: -Routine general medical exam at a healthcare facility.- -The IPPE is a one-time benefit, within a set window of time,- he says.

Better way: Assign V70.5 -for defined subpopulations, since [the exam describes] a very defined population,- says Cynthia Hughes, CPC, American Academy of Family Physicians (AAFP) Coding & Compliance Specialist in a Medical Management Series follow-up speech. The IPPE Medicare beneficiaries represent a special population of people, as do the other groups, such as preschool children, armed forces personnel, and inhabitants of institutions, that ICD-9 categorizes with V70.5.

Step 2: Recognize That CMS Does Not Exclude V70.0

The V70.5 code recommendation, however, is from a technical ICD-9 perspective, not from national CMS policy. -Medicare indicates the IPPE (G0344) has no required diagnosis reporting,- says Alta Bradley, CPC, accounts receivable specialist at ProMed Healthcare/Borgess Health Alliance in Kalamazoo, Mich.

You may still use V70.0 with G0344, says Pat Gill, healthcare coding specialist in the CMS Division of Practitioner Claims Processing. CMS did not include any diagnosis codes in the IPPE's instruction because the agency didn't want carriers denying the IPPE based on providers- use or nonuse of V70.0, Gill explained in a Medicare Contractor Training Conference Call on Feb. 10, 2005. -We wanted carriers to pay for- G0344 if the beneficiary meets the exam's criteria, Gill said.
 
Step 3: Link Most IPPE-Related ECGs to V81.2

CMS is similarly silent on the V code to use with an IPPE-related screening electrocardiogram (ECG). Experts recommend that you report V81.2 (Special screening for cardiovascular, respiratory, and genitourinary diseases; other and unspecified cardiovascular conditions) with G0366-G0368 (Electrocardiogram, routine ECG with at least 12 leads; - performed as a component of the initial preventive physical examination).

Why: ICD-9 instructs coders via a note directly under category V70 to -use additional code(s) to identify any special screening examination(s) performed.- -So it's appropriate to identify the ECG with a special screening code, such as V81.2,- says Jeffrey F. Linzer Sr., MD, FAAP, FACEP, associate medical director for compliance and business affairs at EPG in Atlanta.

Step 4: Entertain History Dx for G0366-G0368
 
When the FP orders an ECG with the IPPE for strictly screening reasons, you should stick with V81.2. But if the patient has a history of heart disease, you could use a V code that represents that condition.

Some history-related alternatives that Linzer suggests include:

- V12.5x--Personal history of certain other diseases; diseases of circulatory system

- V17.3--Family history of certain chronic disabling diseases; ischemic heart disease

- V17.4--- other cardiovascular diseases.
 
-If the patient previously had a myocardial infarction, use 412 (Old myocardial infarction),-   Linzer says.