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personal hx of retinal detachtment

  1. #1
    Default personal hx of retinal detachtment
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    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.

  2. Default
    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).

  3. #3
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    Quote Originally Posted by vpcats View Post
    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).
    As far as I know there is no code for hx of retinal detachment . I agree that you code for why the patient is there so if this is a follow up encounter from a procedure you would use a V67.x code for followup.
    Just to clarify, V are are very acceptable as a principle dx and are acceptable by ALL carriers. We must keep in mind that the dx belongs to the patient and if the V code matches their dx then it is correct. Many times a V code indicates a coverage issue and that is why a payer does not pay the claim but it is the correct code. Some V codes are not allowed first-listed by CDC rule. V42.5 from in the previous post is secondary only allowed. Other V codes are first-listed only allowed like V57.x and V71.x. And still others are allowed in either position.

    Debra A. Mitchell, MSPH, CPC-H

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    I am not sure I understood everything you wrote. I code for physicians. Do you code hospital?

    We can use V42.5 as a stand alone code for topographies following corneal transplants for example.

    I agree you can use V codes if that is the patient's diagnosis. These V codes are considered ancillary codes and are therefore not in the primary position if you want the insurance to pay. If the patient is paying, sure. That's how it should be.

  5. #5
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    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.

    Debra A. Mitchell, MSPH, CPC-H

  6. Default
    Quote Originally Posted by mitchellde View Post
    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.
    You and I do not agree on a few things.
    You may want to check the LCD for Corneal topography (CPT 92015). V42.5 is a covered, stand alone code.

    if a patient comes in for follow up visit during their cataract extraction with IOL post op period, the V43.1 code (pseudophakia) is their current status and we don't bill anyone because it's still during the post op period. If the patient comes in 6 mths later, outside the post-op period, and we are still only seeing the patient for pseudophakia, it becomes a screening exam and payable by the patient.

    We also code diagnoses according to the patient's reason for the visit/problem, not to satisfy insurance. I'm just saying that insurance will not pay for this type of thing. Whereas they'll pay for V42.5 for topography, they will not pay V43.1 for a visit (or anything else) as pseudophakia, barring other medically necessary chief complaints, is a routine visit reason.

    Another V code that is payable, is plaquenil toxicity screening but you need the lupus diagnosis also.

  7. #7
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    I am sorry that we disagree but an LCD cannot dictate a dx code nor its status. The CDC creates the ICD codes and also creates the guidelines, On the first page of the guideline set it will tell you that the guidelines are a set of rules that must be followed and that they are required to be followed. If the original visit is a follow up from surgery then a follow up code is used. V42.5 is a status code to indicate a corneal transplant status and as such is designated secondary only allowed and cannot be used stand alone. So I disagree with you. Also the statement that payers do not payfor/allow V codes first listed is incorrect.

    Debra A. Mitchell, MSPH, CPC-H

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    OK. It's been nice chit-chatting with you.
    We have to follow the LCDs.

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