News & Events
V-Codes Matter!
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 |
|