V Codes: A Classification Whose Time Has Come



As coders we have all used V codes before. But it seems like in today’s coding environment with the advent of Value-Based Purchasing, Meaningful Use, the sequester and RAC, a new spotlight has been placed on a couple of key items; medical necessity and severity of illness. Now these two issues impact all codes being used today, don’t get me wrong. But one of the more interesting things to come out of all this new focus is an increased use of V codes.

V codes are being used to demonstrate severity of illness more than ever to explain circumstances not related to the patient’s current disease or injury, but that impact the level of care by increasing the use of time, and services outside of the patient’s primary illness. Medical necessity is another big topic under scrutiny by RAC and other auditors. V codes with their unique niche in the coding guidelines can turn a denied claim into a deserved payment for the provider.

So let’s take a new look at V codes. If we start with the coding guidelines and do a quick review of the do’s and don’ts of V code use, we can then focus on their increased use in medical necessity and severity of illness situations.

V Code Review

ICD-9-CM has specific codes to deal with encounters that have situations other than a disease or injury. The Supplementary Classification of Factors Influencing Health Status and Contact with Health Services (V01.0 – V91.99) are used when a patient has issues other than a disease or injury that impact care and are recorded as a diagnosis or a problem. There are four primary situations that warrant the use of a V code.

  1. A person who is not currently sick requires health services for reason like, organ donation, prophylactic care, health screenings, counseling for health related issues.
  2. A person with a resolving disease or injury, or a chronic long-term condition requires healthcare for: aftercare of a disease or injury, or continuous care for a chronic condition.
  3. Conditions or problems influence a person’s health status but are not a current illness or injury.
  4. Newborns to indicate birth status.

V codes can be used in any healthcare setting and may be used as a principal or secondary diagnosis depending on the encounter. When coding V codes remember to read the use rules about each code. Some V codes can only be used as a principle or first-listed code while others must always be a secondary code choice. (See section 1.C.18e, V-codes that may only be principal or first-listed codes.) V codes signify a reason for the encounter and should never be used as a procedure code, either ICD-9, Vol. III or a CPT.

V codes fall into categories that represent they type of care being provided. Understanding the intent of each of these categories will help you to assign the correct V code in unique situations.

Contact/Exposure: Category V01 denotes contact with or exposure to communicable diseases. Use for an individual without signs of symptoms of the disease, but have been exposed by contact or through an epidemic. It may be a firstt-listed or secondary code choice. Check the index for other types of exposure such as chemicals, asbestos or lead.

Inoculations and Vaccinations: Codes V03-V06 is used when the encounter is for an inoculation or a vaccination. They are prophylactic inoculation to prevent a specific disease. These codes do not represent the procedure of the injection. V03-V06 codes can be used as a secondary code as well as a first-listed, if the vaccination is part of a routine health exam.

Status Codes: These codes cover several different types of a patient’s status. These codes apply to a) a carrier of a disease, 2) a person with a sequelae or residual of a past disease, 3) a person with a status or condition that impacts levels of treatment for current conditions. Examples include:

  • carrier or suspected carrier of an infectious disease without symptoms;
  • use of prophylactic agents to prevent certain diseases;
  • asymptomatic HIV infection status;
  • incidental pregnancy status, when the pregnancy is complicating the reason for the visit;
  • artificial opening status;
  • postsurgical or procedural status;
  • long-term drug use;
  • genetic carrier status; and
  • body mass index.

History of Codes: There are two types of history codes – personal and family. The personal history codes are used to identify past medical conditions that may re-occur or could have an affect on current treatment of other diseases or conditions. Family history codes are used to identify a patient as having a higher risk of contracting the same disease.

Screenings: Screening is testing on a seemingly well person based on certain factors such as age, population, prevalence of a disease process, in certain groups. Examples include:

  • antenatal screening; and
  • special types of screening exams, bone density, breast and colon cancer and Pap smears.

Observation: These codes are used in very specific circumstances when a patient is being observed for a suspected condition without signs of symptoms of the suspected condition. These codes should be the principal or first-listed code, not the secondary, except in the case of V30 the live born infant, then the V29 observation codes is sequenced as the secondary code.

Aftercare: These codes are used to cover conditions that have been treated initially but require follow-up care for monitoring of the healing or recovery. For example, theyare used to explain continuing surveillance after a treatment has been completed. These codes imply that the disease or condition has been fully treated and no longer exists.

Donors: These codes are used for healthy individuals who are donating blood or tissue for transplant. These codes are used on living individuals who are not self-donating.

Obstetrics and Related Conditions: These codes are used when a pregnant patient presents for care without problems or complications found in the obstetrics chapter.

Newborn, Infant and Child: These codes are used for observation and health supervision of and infant or child.

Routine Administrative Examinations: These codes are use for routing examinations such as checkups or exams for drug tests or employment testing.

The reason that V codes are in the spotlight is the interest in severity of illness scores being used by the APR-DRG groupers. V codes have often been relegated to a second class citizen status, or as “junk” codes that are found at the bottom of the ICD-9-CM code list for billing. They are usually left out of the top nine diagnosis codes – processed by Medicare. Appropriately assigned V codes often don’t make it to the Med PAR data reports.

However, V codes do play a key role in severity of illness and/or risk of mortality calculations. There are only a few V codes that affect reimbursement as CCs in the MS-DRG system, but a large number of them impact risk-adjusted processes used by CMS’s quality efforts and HealthGrades along with healthcare watch groups who publish hospital report cards. V codes can also impact the severity of illness and risk of mortality levels under APR-DRGs grouper logic. Some V codes imply greater severity while other codes, such as V66.7 Palliative Care and V42.x Transplant Status, exclude patients from reporting in select measures.

Medicare is going toward removing the limitations on claims processing. According to the FY11 IPPS Proposed Rule, CMS stated, “We will be able to process up to 25 diagnosis codes and 25 procedure codes when received on the 5010 format starting on Jan. 1, 2011. We recognize the value of the additional information provided by this coded data for multiple uses such as for payment, quality measures, outcome analysis, and other important uses.”

Now let’s take a quick look at some V codes that make an impact on either reimbursement, severity of illness scores or quality of care levels.

Description

Codes

CC

Comments

Prophylactic isolation

V07.0

NO

Admission to protect an individual from his surroundings or for isolation of individual after contact with infectious disease. This code cannot be used as a principle diagnosis code. Use as a secondary code impacts severity scores.

Infection with drug-resistant microorganisms

V09.x

NO

This category is intended for use as an additional code for infectious conditions calcified elsewhere to indicate the presence of a drug-resistance of the infectious organism. Should not be used if there is a code choice that states the disease in combination of the drug-resistance, (e.g., 038.12, MRSA septicemia). Cannot be used as a principle or first-listed code.

Sudden cardiac arrest

V12.53

NO

This code is only used as a history code for a previous episode of cardiac arrest w/successful resuscitation. Coding Clinic, 4th quarter of 2007 advises that this code should not be used code a previous MI, (412). Cannot be used as a principle or first-listed code. Impacts severity scores.

Personal history of a kidney transplant

V42.0

YES

Do not use when coding transplant complication codes. Cannot be used as a principle or first-listed diagnosis. Impacts reimbursement and severity scores.

Artificial opening status – tracheostomy

V44.0

NO

Do not use for acute care of artificial openings. Cannot be used as a principle or first-listed diagnosis. Impacts severity scores.

PTCA status

V45.82

NO

For use when there is a need to identify a previous PTCS. Cannot be used as a primary or first-listed code. Impacts severity scores.

Dependence on respirator status

V46.11

YES

Don’t code with code V46.13, encounter for weaning from respirator, or if any malfunction or complication has occurred. Cannot be used as a principal or first-listed diagnosis. Impacts severity scores.

Attention to gastrostomy

V55.1

YES

Includes closure, repositioning, cleansing, flushing/toileting, replacing catheter; excludes complications of external stoma or status only without need for care. Can be either a primary or secondary code selection. Impacts severity scores and in some cases reimbursement.

Aftercare-following surgery and trauma

V58.43

NO

Codes from this subcategory should be used in conjunction with other aftercare codes to fully identify the reason for the aftercare encounter. Can be used as either a principal or secondary code. Impact on severity scores.

Suicidal ideation

V62.84

YES

Patients have not attempted suicide, and may not be considered a suicide risk, but have indicated thoughts about suicide; excludes suicidal tendencies (300.9). This code can only be used as a secondary code. Impacts both severity scores and reimbursement.

Encounter for palliative care (end-of-life care, hospice care or terminal care)

V66.7

NO

Care is centered on relieving pain, reportable when care is switched in medical record to palliative care. Can only be used as a secondary code. Impact severity scores.

Adult BMI ≥ 40 and over

V85.41-V85.45

YES

Can only be reported if the provider documents the associated condition. Can only be used for adults and as a secondary codes assignment. Impacts both severity scores and reimbursement.

So as you can see, V codes do matter and they can really make a difference on many levels of reporting. So get to know your ICD-9-CM V codes; they are a big help in insuring that your code selection tells the true story of the documentation in the record.

This month’s column has been prepared by Sandra Draper, RHIT, CCS, Director of Training and Development for Precyse (www.precyse.com), which provides services and technologies that capture, organize, secure and analyze healthcare data and transform it into actionable information, supporting the delivery of quality patient care and optimizing operating performance.

Take the quiz and test your knowledge on page 2.

Quiz

1. Is it important to impart through code selection whether or not the patient has had his leg amputated above the knee.
a. Yes, because the patient’s condition impacts his medical care when he is under treatment.
b. Yes, but only if the patient is being treated for a condition that has to do with his amputation.
c. No, it has not barring on the encounter and is just taking up space on the patient’s bill.

2. What V code should be used for an encounter concerning the administration of a DTaP inoculation?
a. V06.2
b. V06.1
c. V06.8
d. V06.9

3. What is the correct assignment of a history of cerebrovascular disease with not neurologic deficits?
a. 438.89
b. V12.54
c. 438.9
d. V12.50

4. What code is used when woman presents for prophylactic breast removal due her extensive family history of breast cancer?
a. V67.0
b. V59.0
c. V50.41
d. V16.3

Answers

  1. a
  2. b
  3. b
  4. c

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