Using v68.1 for medication refill

[nscoder]

Whats the proper use of V68.1 for Medication Refills? Originally my department was using v68.1 as the first listed diagnosis with any associated problems sequenced accordingly but then we got medicare refusals. Should we be coding this another way and if so, is there a guildline to back it up?

[Herbie Lorona]

Well if they are coming for a refill of a medication I would be using the diagnosis for what he is trying to treat with that medication. I would like to know more about the v68.1 and what others are using it for or how it would be used as well

[LTibbetts]

Code the condition first, if it is documented, and the V code as secondary If you are having a problem getting a dx from your provider, maybe try to speak to him/her and discuss the problem it is creating for these accounts. In some cases they might be unaware and grateful for the tip (in a perfect world).

[mitchellde]

V68.x codes are first-listed only allowed. If that is the reason for the encounter then it is appropriate to use. What is the reason being stated as to why the claim did not pay?

[nscoder]

As I understand it, its being denied for the use of v68.1, which when we use, med refill is the only reason for the encounter. But this is only for medicare. So do we use the condition for the med refill w/out v68.1, or is it appropriate to keep using v68.1 w/ the condition?

[LLovett]

I don't think this is very appropriate for most Medicare patients.

They aren't coming just to get the meds, they are coming for rechecks of their chronic conditions that require meds.

The heading of V68 is Encounters for administrative purposes. Based on the examples and the heading this is more along the lines of a dx that would go for form completion charges. Like they are filling out a 3 page form to get a prior auth for a patient to get the name brand instead of generic rx.

I can tell you we don't use it.

Just my opinion,

Laura, CPC, CEMC

[LTibbetts]

After Debs reply to my post yesterday, I spoke with my supervisor and apparantly, this is the primary code (V68.1) that we are to use for our ER patients who come in only for a med refill. As far as Medicare, I do not know as I only do hospital coding. But since the V68 code is only used as a primary, does that mean that for medicare, you can only use the condition code and no V code at all?

[mitchellde]

I am sticking with what was the reason for the encounter. If it truely is to just get a med refil then the V68.1 code is appropriate and Medicare may not pay the visit. Also FYI Medicare does expect this to be coupled with a 99211. If the patient is in for an annual and gets their meds filled as a part of that then it should be a V70 code for the welness, if they are there for a followup encounter and need a refill as a part of the follow up then perhaps a V67 code for the follow up. If they are there for a recheck from an infection and it is determined that they need further antibiotic tx then it is the infection. If they are here for a med check and get a refill then it is V58.83 plus a V58.6x code. So you see it is not just a simple answer you really must look at what is docuemnted and the reason for the encounter. Not every code we use is going to be deemed a payable scenario by one payer or another but we must use the correct dx code for the encounter and then if the patient is responsible go from there. Remember the dx belongs to the patient!

[nscoder]

I do understand that the dx depends on the scenario. In this case the medical clinics are in rual villages and the patients routinely make an apointment to recieve their meds (almost like a pharmacy). There is no review/change of the medication, no exam. Just a cheif complaint (med refill) and the meds given.

I began to query these for the diagnosis/reason for the meds, and used that as the first dx.