Reimbursement Advisor

Easier reimbursement: How the new ICD-9 helps

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Report fifth-digits 0 and 2 even if the patient requires insulin—in which case, you may also report the new code V58.67 (long-term current use of insulin). This can be used as a secondary diagnosis, or as a primary diagnosis when the patient is seen for possible long-term effects rather than diabetic control. (Long-term current use of aspirin was also given a code, V58.66.)

V code changes Gynecologic exam

Per ACOG’s request, V72.3 has been expanded into 2 codes:

V72.31 covers routine gynecologic examination—including a Pap smear, if performed. Thus, do not report V76.2 (special screening for malignant neoplasms, cervix) with V72.31 for the exam. Note, however, that if the patient’s cervix is absent and a vaginal Pap smear is collected at the time of the visit, code V76.47 (routine vaginal Pap smear) is also needed.

V72.32 describes a repeat Pap smear in the following scenario: A patient has an abnormal Pap test and is brought back 3 months later for a follow-up Pap. (The diagnosis for that visit is the abnormal result.) The results come back normal and she is asked to return in a few months. You will use V72.32 for this last encounter.

ACOG clarifies V72.32 may be used more than once at the physician’s discretion, since the usual protocol is to perform more frequent Pap smears until obtaining 3 consecutive negative results. Caveat: Check with your Medicare carrier before using this code for the repeat Pap smears.

Pregnancy tests

With the expansion of V72.4, ICD-9 now has an option for a pregnancy test done prior to a procedure that may harm a fetus, or simply because you suspect pregnancy:

Use V72.40 when you perform a pregnancy test, but have not determined whether the patient is pregnant by the end of the visit (ie, a blood rather than urine test). Note that if the pregnancy test is positive, also report code V22.X, per ICD-9 guidelines. This pregnancy diagnosis can be linked to the CPT pregnancy test code.

Use V72.41 if you confirm she is not pregnant during this visit. (Again, if the test is positive, use code V22.X.)

Hormone replacement therapy

The term “postmenopausal” was moved to a parenthetical note for code V07.4, to denote that this code should be reported anytime a woman is placed on estrogen replacement therapy. ICD-9 also has clarified that it is not appropriate to use V58.69 (long-term [current] use of other high-risk medications) for patients on hormone replacement therapy—instead, select code V07.4.

Screening for osteoporosis

ICD-9 has clarified that code V07.4 should be reported with the code for osteoporosis screening (V82.81), if applicable.

Genetic susceptibility to disease

A new category addresses prophylactic organ removal. Until now, ICD-9 had codes to indicate that an encounter was for organ removal, but not to describe the reason for the removal.

Further, these codes were needed because the “carrier status” codes can be used only when the patient is a disease carrier, able to pass it to offspring—not when she herself is at risk.

Note that before you can use these codes, the patient’s record should show an abnormal gene confirmed by genetic test.

Acquired absence of organ

ICD-9 has clarified that code V45.77 (acquired absence of genital organs), excludes the new FGM status codes (629.20 to 629.23).

Exposure to communicable diseases

The American Academy of Pediatrics requested the addition of exposure codes to viral and other communicable diseases. Most important to Ob/Gyns is exposure to chickenpox (varicella), if the mother was not previously exposed. This new code, V01.71, may be enough to support the medical necessity for laboratory work to test for immunity to chickenpox.

Report code V01.79 for exposure to other viral diseases.

Lack of adequate sleep

New code V69.4 is reported for sleep deprivation, but excludes insomnia.

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