V-Codes Matter!

Posted by Susan Wallace, MEd, RHIA, CCS, CCDS on 07/27/2010

Very Important Codes!

V-codes have long been considered step-children, supplemental codes that are typically relegated to the end of the list of ICD-9-CM codes.  Since Medicare has only processed the top nine (9) diagnosis codes, even when all of the pertinent V-codes are assigned, they are frequently omitted from the MedPAR data because of their place in line.

But V-codes DO matter as they impact the patient’s severity of illness and/or risk of mortality.  A handful of these V-codes affect reimbursement as CC’s in the MS-DRG system, but many more impact risk-adjusted methodologies used by CMS, HealthGrades and other organizations who publish hospital report cards.  V-codes can also impact the severity of illness and risk of mortality levels under APR-DRGs.  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.

Limitations in Medicare claims processing are nearing resolution.  According to CMS, they “will be able to process up to 25 diagnosis codes and 25 procedure codes when received on the 5010 format starting on January 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.”  FY11 IPPS Proposed Rule

Now is a great time to reassess hospital coding policies to assure that expectations for V-code reporting are clear.

Potentially significant V-codes are listed in the table that follows.

 

 

Code

CC

Description

Notes

V07.0

 

Prophylactic Isolation

Admission to protect individual from his surroundings or for isolation of individual after contact with infectious diseases

V12.53

 

Personal history of sudden cardiac arrest

Only for previous episode of cardiac arrest w/ successful resuscitation; not for history of  MI (412)

V15.1

 

Personal history of surgery- heart & great vessels

Not intended for transplant status

V15.51

 

Personal history of traumatic fracture

 

V15.52

 

Personal history of traumatic brain injury

Excludes hx CVA w/o residual deficit

V42.0

Yes

Personal history of kidney transplant

Not for use with transplant complication codes

V42.1

Yes

Personal history of heart transplant

V42.4

 

Personal history of bone transplant

V42.6

Yes

Personal history of lung transplant

V42.7

Yes

Personal history of liver transplant

V42.81

Yes

Personal history of bone marrow transplant

V42.83

Yes

Personal history of pancreas transplant

V42.84

Yes

Personal history of intestine transplant

V42.89

 

Personal history of other transplant

V42.9

 

Unspecified organ or tissue transplant

V43.21

Yes

Organ or tissue replaced by other means – heart assist device

V43.22

Yes

Organ or tissue replaced by other means – fully implantable artificial heart

V44.0

 

Artificial opening status – tracheostomy

Excludes artificial openings requiring attention or management

V44.1

 

Artificial opening status – gastrostomy

V44.4

 

Artificial opening status – Other artificial opening of GI tract (not ileostomy or colostomy)

V44.50

 

Artificial opening status – cystostomy

V44.51

 

Artificial opening status – cutaneous – vesicostomy

V44.52

 

Artificial opening status – appendico-vesicostomy

V44.59

 

Artificial opening status – other cystostomy

V44.6

 

Other artificial opening of urinary tract

V45.4

 

Arthrodesis status

Ankylosis of joint afterl fusion, not when problem requiring refusion or revision

V45.74

 

Acquired absence of organ - other parts of urinary tract

 

V45.75

 

Acquired absence of organ – stomach

 

V45.76

 

Acquired absence of organ – lung

 

V45.81

 

CABG status

 

V45.82

 

PTCA status

 

V46.11

Yes

Dependence on respirator status

Not for use w/ V46.13; only if no complication or malfunction of respirator

V46.12

Yes

Encounter for respiratory dependence during power failure

Principal DX only

V46.13

Yes

Encounter for weaning from respirator

Principal DX only

V46.14

Yes

Mechanical complication of respirator

For ventilator equipment malfunction

V46.2

 

Dependence on supplemental oxygen

Regardless of duration of use each day, intended for long-term oxygen therapy

V49.76

 

Above knee amputation status

 

V49.83

 

Awaiting organ transplant status

 

V49.86

 

DNR Status – NEW 10/1/10

Potential data implications unknown

V54.01

 

Encounter for removal of internal fixation device

After active treatment completed, for routine care during healing / recovery phase

V54.09

 

Other aftercare involving internal fixation device

V55.0

 

Attention to tracheostomy

Closure, repositioning, cleansing, flushing / toileting, replacing catheter; excludes complications of external stoma or status only without need for care

V55.1

Yes

Attention to gastrostomy

V55.2

 

Attention to ileostomy

V55.3

 

Attention to colostomy

V55.4

 

Attention to other artificial opening of digestive tract

V55.5

 

Attention to cystostomy

V58.43

 

Aftercare following surgery for injury and trauma

 

V58.44

 

Aftercare following organ transplant

Seen on routine basis to assess functioning of new organ; may be used w/ V42 transplant status code

V58.49

 

Other specified aftercare following surgery

 

V61.21

 

Counseling for victim of child abuse

 

V61.22

 

Counseling for perpetrator of parental child abuse

 

V62.84

Yes

Suicidal ideation

Patients have not attempted suicide, may not be considered suicide risk, but have indicated thoughts about suicide; excludes suicidal tendencies (300.9)

V66.7

 

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

Care aimed only at relieving pain and discomfort to be applicable;  reportable regardless of what point during stay care is switched to palliative

V85.0

Yes

Adult BMI <19

Reportable only if provider documents associated condition, meets guidelines for reportable secondary diagnosis

V85.41-V85.45

Yes

Adult BMI >40

New code expansions 10/1/10

For the pdf version click here.

 

V-codes have long been considered step-children, supplemental codes that are typically relegated to the end of the list of ICD-9-CM codes.  Since Medicare has only processed the top nine (9) diagnosis codes, even when all of the pertinent V-codes are assigned, they are frequently omitted from the MedPAR data because of their place in line.

 

But V-codes DO matter as they impact the patient’s severity of illness and/or risk of mortality.  A handful of these V-codes affect reimbursement as CC’s in the MS-DRG system, but many more impact risk-adjusted methodologies used by CMS, HealthGrades and other organizations who publish hospital report cards.  V-codes can also impact the severity of illness and risk of mortality levels under APR-DRGs.  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.

 

Limitations in Medicare claims processing are nearing resolution.  According to CMS, they “will be able to process up to 25 diagnosis codes and 25 procedure codes when received on the 5010 format starting on January 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.”  FY11 IPPS Proposed Rule

 

 

Now is a great time to reassess hospital coding policies to assure that expectations for V-code reporting are clear.

 

 

Potentially significant V-codes are listed in the table that follows.

 

 

Code

CC

Description

Notes

V07.0

 

Prophylactic Isolation

Admission to protect individual from his surroundings or for isolation of individual after contact with infectious diseases

V12.53

 

Personal history of sudden cardiac arrest

Only for previous episode of cardiac arrest w/ successful resuscitation; not for history of  MI (412)

V15.1

 

Personal history of surgery- heart & great vessels

Not intended for transplant status

V15.51

 

Personal history of traumatic fracture

 

V15.52

 

Personal history of traumatic brain injury

Excludes hx CVA w/o residual deficit

V42.0

Yes

Personal history of kidney transplant

Not for use with transplant complication codes

V42.1

Yes

Personal history of heart transplant

V42.4

 

Personal history of bone transplant

V42.6

Yes

Personal history of lung transplant

V42.7

Yes

Personal history of liver transplant

V42.81

Yes

Personal history of bone marrow transplant

V42.83

Yes

Personal history of pancreas transplant

V42.84

Yes

Personal history of intestine transplant

V42.89

 

Personal history of other transplant

V42.9

 

Unspecified organ or tissue transplant

V43.21

Yes

Organ or tissue replaced by other means – heart assist device

V43.22

Yes

Organ or tissue replaced by other means – fully implantable artificial heart

V44.0

 

Artificial opening status – tracheostomy

Excludes artificial openings requiring attention or management

V44.1

 

Artificial opening status – gastrostomy

V44.4

 

Artificial opening status – Other artificial opening of GI tract (not ileostomy or colostomy)

V44.50

 

Artificial opening status – cystostomy

V44.51

 

Artificial opening status – cutaneous – vesicostomy

V44.52

 

Artificial opening status – appendico-vesicostomy

V44.59

 

Artificial opening status – other cystostomy

V44.6

 

Other artificial opening of urinary tract