Who'd boo a coding compliance auditor?! They keep us all on track.
Under normal circumstances, you'd want to sequence your mental health diagnoses first--in a manner fitting the "first-listed" diagnosis rules in ICD-9. That means whatever condition the patient has that was the clinical focus of the visit or encounter is sequenced before others, chapter-specific ICD-9 guidelines may apply.
You mention these are for pre-organ transplant purposes (at least sometimes). That makes me believe the V72.8X series might be most appropriate for your primary diagnosis on those cases. The service (from what I'm gathering) seems to be pre-operative in nature and concerning the patient's capacity to tolerate the rigors of the physical transplant.
On the other hand, you mention the psychiatrists seeing patients "with a medical diagnosis." Although that is the case, I'm led to believe psychiatrists are unlikely to manage those medical conditions as primary. Their scope of practice would impact the selection of your primary dx--make sense? As consultants or clinical managers of the patient's psychiatric conditions, and in rendering a psychiatric service to these patients, I would expect to see a mental health dx listed before any medical conditions, unless otherwise advised through ICD-9 coding rules.
Keep in mind, there are dx in the Mental Health Disorders chapter that read "secondary to a general medical condition." (See 293.0, though that is not the best example and I am relying on memory here). Those may be more appropriate in some instances.
Definitely get a copy of DSM-IV-TR. Although we code in ICD-9 and follow its rules, DSM is very helpful when you're trying to sort out diagnostic issues related to mental and behavior health medical necessity.
Good luck and I hope this has assisted you in some way!
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