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V70.0 Well Visit- Should you code additional diagnosis

  1. #1
    Unhappy V70.0 Well Visit- Should you code additional diagnosis
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    Hi,

    When coding a annual CPE for a patient that has a hx of Hypertension, should we also code the diagnosis 401.9 Hypertension along with v70.0? In our office, we code based on what the physician discussed with the patient even at a well visit.

    We have seen certain payers deny claims if the additional diagnoses are coded along with the v70.0.

    Thanks,

    Jackie

  2. Default
    What insurance denied??? If the doctor puts other diags on the router, I add them - V700 always listed first.

  3. #3
    Location
    Dover Seacoast New Hampshire
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    1,971
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    If the intent of the visit is preventive, and the documentation supports it, then you have provided preventive care, but you should make sure that the V70.0 is always coded first. You may also document and code for additional diagnoses; make sure that the HPI, ROS, exam and assessment/plan all include and support the provider's addressing the additional code. I'd question the payer as to why you're getting denials for a secondary code inclusion during a preventive visit. It's routinely done here, without issue.
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  4. #4
    Default
    Hi,

    Actually it was BCBS POS and I need to re-state the question.

    We billed a v70.0 for a well visit, the pt had been in 3 weeks earlier for Hypertension 401.9. At the physical, the pt 's visit was billed with the appropriate E/M code and was put to V70.0. We did NOT indicate any additional diagnoses on the claim with the physical. But the claim was denied stated that previously the pt had a diagnosis of 401.9

  5. #5
    Location
    Columbia, MO
    Posts
    12,570
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    Quote Originally Posted by jrush7779 View Post
    Hi,

    Actually it was BCBS POS and I need to re-state the question.

    We billed a v70.0 for a well visit, the pt had been in 3 weeks earlier for Hypertension 401.9. At the physical, the pt 's visit was billed with the appropriate E/M code and was put to V70.0. We did NOT indicate any additional diagnoses on the claim with the physical. But the claim was denied stated that previously the pt had a diagnosis of 401.9
    I am not sure I understand... You billed a V70.0 with a visit level ? (99211-99215) or did you bill it with a preventive E&M code? ( It should be the preventive code.)
    And they denied it because you did NOT use a 401.9 as a secondary?

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Default
    Hi debra,

    We billed v70.0 with cpt code 99395 at her physical appt. 3 weeks prior she had come in for an office visit and the diagnosis then, was 401.9 hypertension. BCBS denied the EKG part of the Physical Exam stating that this part was not covered because she had a prior diagnosis of 401.9.
    This is not new insurance for the pt, nor had she been told it was denied as a pre-existing condition. We are baffled as to why it was denied.

  7. #7
    Location
    Dover Seacoast New Hampshire
    Posts
    1,971
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    The payer is referencing the previous diagnosis of 401.9 when you billed out the EKG with the Pe. Some payers consider the V70.0 code a 'screening code'. ICD-9 indicates you can't bill a screening code if you have already established a symptom or condition. That's why it was denied. The 401.9 is going to pop up as a pre-existing condition anytime a claim is submitted for that patient. Tthis means you can no longer provide any kind of related screening, because the patient already has a condition. Hopefully, the patient truly has HTN, and not just elevated BP, because according to the payer, your patient is hypertensive.
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  8. #8
    Location
    Columbia, MO
    Posts
    12,570
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    I agree with Pam. It cannot now be preventive or screening it could be med monitoring, V58.83 plus a v58.6x code for the medication due to the HTN, or to check the HTN status which would be the 401.9 linked to the EKG but having had one just 3 weeks prior may still make this one not medically indicated.

    Debra A. Mitchell, MSPH, CPC-H

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