Pediatric Coding Alert

Use Diagnosis Codes, Not V Codes, for Preoperative Clearance


- Published on Fri, Jun 01, 2001

Many private payers refuse to recognize V codes V72.81 (preoperative cardiovascular examination), V72.82 (... respiratory ...) and V72.84 (... unspecified) as primary diagnoses for preoperative clearance.

To address this problem, list the diagnosis prompting the surgery rather than the V code as the primary diagnosis, recommends Donelle Holle, RN, manager of professional fee services at the University of Michigan Health System, department of pediatrics, in Ann Arbor. Joel F. Bradley, MD, FAAP, editor of Coding for Pediatrics, a member of the AAP coding and reimbursement committee and a practicing pediatrician in Clarksville, Tenn., concurs. The proper diagnosis is the one necessitating the surgery.

Because this diagnosis is likely to be serious, payers computers wont reject it. And using such a diagnosis is proper coding: After all, you would not perform the preoperative exam unless the child had the problem. Use the V code as a secondary diagnosis, showing that a preoperative examination was performed.

For example, a patient may have caries, calling for extraction of a tooth. For a child, this requires a surgical procedure with anesthesia, and therefore a preoperative clearance is necessary. List 521.0 (dental caries) as the primary diagnosis and V72.84 as the secondary diagnosis.

In another example, a child suffers repeated ear infections. The pediatrician sends the patient to an otolaryngologist, who determines the child requires tubes. The specialist returns the patient to the pediatrician requesting that he or she perform a preoperative clearance exam. Report the service with chronic otitis media (381.x or 382.x) as the primary diagnosis and V72.84 as the secondary diagnosis.

Dental Insurance May Require V Code

If a childs dental insurance is separate from his or her medical insurance, and he or she requires dental surgery, use preoperative clearance not the dental diagnosis as the primary diagnosis. The medical insurance will not cover dental in this case, and therefore a dental diagnosis should not be billed. The only exception is if there is an abscess, in which case coverage moves from dental to medical.

When there is no dental coverage, however, report the surgical diagnosis as primary.

Chronic Condition

Some children have chronic health conditions that complicate both the surgery and the preoperative exam. According to some insurers, this is the only time that a preoperative clearance exam is medically necessary.

Use three diagnosis codes for preoperative exams of children with chronic conditions, the first representing the chronic condition, the second for the condition that necessitates the surgery (such as tubes or dental caries) and lastly the appropriate V code.

Some payers expect V72.81 and V72.82 to be performed by specialists cardiologists or pulmonologists, respectively while others allow the primary care physicians to perform them.

For example, [...]

Pediatric Coding Alert
Issue - Jun, 2001
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