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Family History vs Personal History as Primary

Janelle926

Contributor
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Watertown
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When coding does it make a differance on whether you use a personal history V Code or family history V Code as the primary diagnosis? Ex. Colon Screening, Pt has personal history of polyps V12.72 and also has family history of colon cancer V16.0, nothing found.
 

ohn0disaster

Expert
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Stuart, Florida
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Yes, it matters.

As is the case for all V-codes, some of them are additional dx ONLY, some are additional or 1st list dx, and some are 1st list dx ONLY. There are also some V-codes that fall under non-specific diagnosis, which are "primarily for use in the nonacute setting and should be limited to encounters for which no sign or symptom or reason for visit is documented in the record" and can be 1st listed or additional codes.

I'm not sure what ICD-9-CM book you use but, if you use the Ingenix Professional edition, there is a table in the front of the book, in the Coding Guidelines, which tells you about the order the V-codes can be used in. I'm unsure as to whether or not this is included by the publishers of other ICD-9 books. I know that Ingenix Standard edition does not include this, unfortunately, and I've never owned anything but the Professional and Standard editions.

As for the V16.X and V12.X code ranges, they can be used as 1st listed or additional (2ndary) DX codes, per the Coding Guidelines.

Hope this is helpful! :D
 

ohn0disaster

Expert
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Stuart, Florida
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Just wanted to add that, if the documentation is for screening, as Debra stated, the screening code would be the first listed code. My first post was just to point out how you would know what order is ALLOWABLE for the V-codes.
 

JenReyn99

Guru
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Redding, CA
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Also, I've just recently been made aware that in the ICD-9 guidelines, it tells you that if a patient has had a previous polyp discovered on a colonoscopy, then they are no longer eigible for the V76.51, you would have to use the follow-up code V67.09, or just code to the highest level of specificity which is the V12.72. This is the way I do it, and it works out just fine. Also, remember to use your new 2011 modifiers if it starts out as a screening.
 

Janelle926

Contributor
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Watertown
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Now lets say the patient comes in for a screening and the Dr removes a polyp by snare we code as 45385, V76.51,211.3... Ive heard we need to change the pointer to 2 to link the polyp to the cpt... My system that we use will not allow us to change this. Has anyone else had this problem or had issues being paid due to this?
 
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