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V43.3 Used as Primary DX?????

  1. Default V43.3 Used as Primary DX?????
    Medical Coding Books
    Ok, I have a hot debate, I follow all guidelines and in my ICD-9 guidelines it shows which V codes are used as primary, additional, or both. I have a co worker that has been using
    V43.3 as primary dx for Prothrombin Time Monitoring for Home Anticoagulation Management. Basically she bills out a G0248 or G0249 using the V43.3 dx. Now I have seen the Medicare Claims Processing Manual that states to use V43.3 as one of the dx for this service. My question is this, if our ICD-9 books from the AMA state that the V43.3 code can only be used as a secondary code, is Medicare then saying well we can change the rules and bill this V code primary? Or do we look at this as yes, Medicare says we can use V43.3 but as coders we should know our guidelines and first bill an appropriate primary code?
    Anyone, Please respond with some answers to this!!! I really feel that this code should not be billed as a primary dx if that is what our books say but I will admit when wrong if I am. Calling all coders to help figure this out!!! Thanks, Gail Davis, CPC

  2. #2
    Columbia, MO
    I agree. I would think a better way to code this would be

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    Thank you for the response!!

  4. Default
    Would anyone else have some input on this V code? Thanks, Gail

  5. #5
    Columbia, MO
    V43.3 is a status code that only indicates a status of having had a heart valve replaced, it does not indicate the reason for the encounter. V58.83 is a code for "Encounter for therapeutic drug monitoring" and does describe the reason for the encounter, V58.61 is a status code that again only indicates a status of being on an anticoagulant not why the patient is being seen. Therefore in the final analysis the only code that indicates the reason for the encounter is V58.83.

    Debra A. Mitchell, MSPH, CPC-H

  6. Default
    Medicare makes up their own rules all the time. If they accept V43.3 as primary and do not recoup, there's no reason to debate textbook rules. But I would personally code further just in case they do decide to recoup payment based on textbook reasoning.

  7. #7
    Columbia, MO
    Medicare cannot make up the rules for diagnosis use or placement. The ICD-9 codes are created by Medicare. The rules for ICD-9 are created by The CDC and are mandated to be adheared to under HIPAA. This last year Oct 1 2010, several V codes that were previously classified a secondary only allowed have had that status removed. The code book publishers may not yet be caught up. If you go to the guidelines updated for OCt 1 2010 you will see in the V code section that only a few V codes are stated as secondary only. The V43.3 is allowable as first list per the guidelines. I just feel the better way to code is with the V58.83 listed first. So while it may appear that Medicare is making up their own rules, they are not.

    Debra A. Mitchell, MSPH, CPC-H

  8. Default
    I agree, Thank you!

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