When coding the diagnosis of a follow-up visit, the original diagnosis code from the previous visit does not often give the payer enough information to prove medical necessity. Coders use V codes for further explanation. "It may decrease the likelihood that the claim will be denied for lack of medical necessity,'' says Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc., a healthcare consulting firm based in Lansdale, Pa. "It tells the whole story. It gives a more complete picture."
Because Medicare and private carriers do not always pay for services linked with V codes, you must determine when they will enhance payment and when they will cause denials.
Billing as a Secondary Code
Sometimes, coding a follow-up visit calls for a V code to supplement the original diagnosis code. For example, a patient who had mononucleosis comes in three months later. The patient presents with symptoms of swollen glands and a fever and is afraid she has a recurrence of mononucleosis. The physician conducts blood work and determines that the patient does not have mononucleosis but has a viral infection. Use 079.99 (unspecified viral infection) as primary and V12.09 (personal history of certain other diseases; infectious and parasitic diseases; other) as secondary. "In this case the V code indicates that the patient has a history of mononucleosis, which may help justify the medical necessity for the blood work," Falbo says.
When the Code Stands Alone
According to the American Hospital Association, V codes can be used as the principal diagnosis "To indicate that a person with a resolving disease or injury or a chronic condition is being seen for specific aftercare, such as the removal of orthopedic pins." Often "specific aftercare" qualifies as the global period, and although the appropriate V code should be used for coding accuracy, a follow-up visit during the global period will not be reimbursed. However, a V code can be billed instead of the original diagnosis code for a follow-up visit to ensure that the condition is resolved and the patient is no longer at risk.
When a physician is following the course of a patient on serious therapeutic drugs, use of the V code is correct and payable. For example, a patient with attention deficit hyperactivity disorder (ADHD) has been on Ritalin for six months. He comes in for a follow-up visit so the FP can monitor how [...]