Stenglein
Networker
How would we code a diagnosis of personal hx of retinal detachment? I have looked at V codes, but am not exactly satisfied with what I am seeing.
Why did the patient come to see you? Can you use the reason for visit/chief complaint?
If it was a screening exam because they "just" have a history of a non-existent problem (and you want to confirm there is no problem now and nothing new is developing), it is usually self-pay.
V codes are not payable as a primary diagnosis by most payers (except the V42.5).
V42.5 is secondary only regardless of whether you code for acility or physician. It is a status code. Not all V codes are ancillary codes and some are only allowed to be used as first listed codes. We code for the patient's diagnosis not for the insurance company. The presence of a V code first listed is not why an isurance does not pay. In a lot of circumstances a V code indicates coverage issues and that is the reason the claim is not paid. If the visit is a followup encounter then you have to use a V code for follow up. There are numerous instances where a V code should be the first listed code. But V42.5 cannot be a stand alone or first listed. Your ICD-9 book contains a designation for this code as secondary only. Also go look at the coding guidelines for V codes and you will see the listing of first only allowed.