Alicia: We’re going to talk about V codes. We have talked about V codes in the past and still they’re complex sometimes. And then once you get it, once it clicks in your head, it’s like, “Oh! OK, I got it.” But every once in a while they’ll throw a zinger, you’ll experience something that you think, “I’m not sure exactly what I need to do.”
Q: I get confused when looking at V codes. They are mixed into the index. What keywords will help me find the right V code?
A: I think what they’re saying is they’re mixing the index where it’s like E codes have their own index separated but V codes are in with the general codes. V codes are reported to support services that are rendered when a patient does not have an acute medical condition. These are the basic sections for V codes. What I would encourage you to do if you struggle with V codes is, one, go to the section in your ICD manual that specifically talks about V codes and that starts with V01, and read, just peruse them and kind of get familiar with what options are out there. I divided these up: Exposure, if you’re exposed to something, you’ve got to paint that picture for the provider and for statistic purposes so that they can follow the treatment. The one I picked because I thought that was unusual, like we had it on [undecipherable]. Anthrax was going through the post office and stuff, so let’s say you had a postal worker that had been exposed to anthrax. This is the code that you would use and the way you look it up is by that key term “exposure.” Then, you’re going to go “to”; so “exposure to” to what? Anthrax. And that gives you V01.81; so anytime somebody is exposed to something, then you get to use a V code for exposure.
The next one: Inoculation & Vaccinations. I don’t know that there’s a difference – you can correct me if you know the difference – if there’s a difference between inoculation & vaccination. You know, “I’m going to give you a vaccination,” but they’re saying, “I’m going to give you an inoculation.” That will be something you can Google and see what the difference is. But to look these up, you’re going to look under the term “vaccination.” Now, there are different types, but let’s say it’s prophylactic – meaning, you’re doing it so you don’t get something; so vaccination to protect you from what? And there’s a whole list of different things that you can be protected from with the vaccination.
Chicken pox – I remember when that came out because in the past you just took your kids to whoever’s family had chicken pox in the neighborhood so they can get exposed and get it in their system and you won’t have to worry about it. But now there’s actually a vaccination for it. I remember out of the six children, the first one that got vaccinated for chicken pox and supposedly they weren’t supposed to get it. Or, if they do, they get a less severe case, is what I think I was told. Now, it’s V05.4. If you have children going in for well-baby checks and seeing the pediatrician, this is going to be something in the pediatrician’s office; that is going to be a very common code for you for vaccinations and V05.4 for chicken pox.
Another main term and this one is overlooked frequently. The reason I’m more familiar with it is with the HCC coding, a lot of status codes carry HCCs and they want to be captured for those chronic conditions for raising their score. But they’re overlooked, because if you’re coming in for a cold and the patient has colostomy, the doctor is not really there to look at the colostomy; however, if it’s an HCC thing, then you’re looking for anything that is a diagnosis related, carries an HCC and colostomy would.
So, you always look under “status” and if you weren’t familiar with the status codes, which I think we did a short segment on status codes in the past, you’ll have to look that up in our Replay Club, or check maybe Boyd put that on YouTube on our membership area. But the term is “status.” In your index, in your ICD, look up the term “status.”
Now, this one is “post” so status after a colostomy. This person’s got a colostomy, it’s V44.3. And there are other status codes, like, there are other kinds of “-ostomies “that a person can have –urostomy, tracheostomy. But another status post, below-the-knee amputation or above-the-knee amputation, which is BKA and the other one.
Then the other things that you’re going to see in status, let me see if I can think of – status ventilator and people think, “Well, that might be someone that needs to be in a bed” – you know, you think of the big ventilator system. That’s not true. There’s actually ventilators – well, of course people in a wheelchair, maybe your quadriplegic; but I saw a picture of a girl going to school, at college, and having her ventilator thing. Anyway, it was very interesting.
A big one – that is the History codes, this is probably the first one that I learned of the V codes was the history codes, and it’s divided up into two sections, your history codes. Now, you still look under your key term of history, in your index; so you’re going to look history-personal or family. Which this one, blew my mind because when I found it, I didn’t realize this code was in here because I’ve never had to use it. But hey, it’s a pretty cool code.
What is Medical Coding – Understanding V Codes – Video
History, personal, death – and I thought, “Oh, OK you’re dead, how can you get a code? – sudden (maybe they have a heart attack or something), successfully resuscitated. I mean, how cool is that? So, V12.53 – that might not even be a code that you’re aware of that can be used. For statistical purpose, you can see how important it would be to capture this, occurred in a patient. Again, that’s when I wasn’t even aware of; maybe I had known about it, but I’ve never had to actually use that code. But just going in and reading these history codes will teach you that they’re there so that you can use them.
Now, a family history is – again, you don’t have the condition but someone in your family had the condition; so history is your key term – family and then epilepsy, or types of cancer, maybe cardiac conditions or cerebrovascular conditions and stuff. And you can see how important, again, not just to statistic purposes but for your health, like, you have a family history of breast cancer, you definitely want to make that notated because the doctor wants to monitor that. You may need to get a mammogram earlier than might have been recommended for other people and your insurance company says, “Well, I’m not going to pay for a mammogram for a 20-year old,” but if they have a family history of breast cancer, then it make sense, doesn’t it?
Another key area that V codes are used is for Screenings, any types of screenings. Now, this gets a little confusing with screenings, because sometimes you don’t think about something being done for a screening. Again, go back, look in the index, look at screenings as your key term, and there’s a big long list of different things that people are screened for. The one I pick to show you was lead poisoning, because if you’ve lived in a house that is a certain age, the paint is something that was a concern about. In the windows where paint chips, if you live in an old house, they’ll ask you – pediatricians often will ask if the children are exposed to lead paint. Again, you can get lead poisoning, from that if a child eats that or gets that on their hands. If they’re worried about lead poisoning, they would do a screening for lead poisoning, V82.5.
If we scroll down a little bit more, there’s more. It’s not really an extensive list, but these are the main terms here for V codes. If you want to get savvy with your V codes, again these are the main ones to look at.
For Observation, you’re going to look up the key term “observation.” The one I picked was suspected, concussion, cerebral; so you look up “observation, suspected, concussion, cerebral.” Again, they’re coming back for a visit because they want to see. He got hit in the head playing football and we just want to make sure that he doesn’t have a concussion; and so, that’s why he’s being seen today for observation to confirm whether he does or does not have that. That’s a V71.6; big long list of different things that can be done in the observation.
Now, Aftercare and Follow-Up Care, they get confusing; but if you know these little definitions, for aftercare – that means that it’s after the acute phase. You’re actively getting treatment for whatever it is that you’re coming in for the aftercare; but it’s no longer acute. The example that I came up with was a fracture. Again, the key term is aftercare. Let’s say your patient is coming in for aftercare because they had a fracture, but it’s healing but it’s also a pathological fracture and location (it’s at the ankle), that would be V54.29.
So, your key term is “aftercare” so it’s no longer acute, it’s in the healing process. So why are they coming in? Well, they had a fracture and it’s healing, so you’re going to keep indenting here to get this. What type of a fracture was it, besides healing? Well, it was a pathological fracture – meaning, there was a disease process going on. Maybe your patient was an 80-year-old female with osteoporosis or osteosclerosis; and so, their bone is more brittle and porous. She stepped off of her step and bam! Her ankle snapped. That would be V54.29.
Unlike follow up, follow up is different because the condition is healed. When you look up in the index, go under “follow up.” One of the ones that was unique and I remember a friend having this, they had to go in for follow up for a little while because they were taking a high-risk medication, which is V67.51, and they were very concerned about because his appendix burst and he had all kinds of complications. Because of the medication, the antibiotic that they put on him was so strong; they were very concerned about it infecting his other organs. So, even after everything was taken care of, he had to go in for a period of time and follow up with some blood work just to make sure that that medication, which was high risk, had not caused damage. V67.51 reflects that. It’s not an acute phase but he’s still going for a follow up.
One that I’ve not used to seeing very much or don’t think about too much and maybe you don’t either, might not even been aware there’s a V code for this, but it’s for Donors. This code is not maybe what you’re thinking. It’s not used for when an organ is harvested or if you’re doing self-donation. If you know you’ve got to have a blood transfusion later because you’re having a procedure done, then you go in and have them store your blood for you, for your procedure so they can give it back to you. That’s not included in this. Instead, this is if you’re giving something, you’re donating to somebody else. And it also does not include harvesting from a cadaver, that doesn’t count in this V code area either.
A perfect example of this is bone marrow. When you go to find this code, you’re going to look under “donor” and then if it was bone marrow, it would indent into “bone.” Now, people donate bone as well, probably for a family member or something. I don’t think you’re just going to go let them shave off a piece of your hip just for no reason. But the code for donor for bone is V59.2, and then it indents and it says “donor, bone, marrow” V59.3. And again, that is getting to be more and more popular because just a little bit of maybe your bone marrow that they would take, I think usually out of the hip bone or the pelvis, it could be put into a person that has maybe a type of leukemia or cancer or something and they get a bone marrow transplant. But all your numbers and stuff have to connect, so you see those websites and you see people going in and being tested to see if they can donate their bone marrow to a friend. So that would be the code that would be used.
The second to the last one is Counseling. This is something, probably as a coder you’ll see more often is you need to let them know if counseling is being done. Again, the keyword is “counseling. ” This one expectant parent for pediatric pre-adoption visit, V65.11. There are all kinds of rules and regulations with adoption, and again, counseling needed to be done before you’re allowed to adopt and this would be a code. I did not realize that they had a specific code for pre-adoption visits. The other ones for, like, dietary counseling and mental illness and abuse for like tobacco, things like that, those you think about that; but the V65.11 that was a new one for me, that we never had any occasion to use that.
Last one – Routine & Administrative Exam. I think these are the most – I don’t want to say they are the most common V codes, that’s probably not a good thing to say because it really depends on where you work to say whether it’s a common one. But I think a lot of people are aware of these V codes for the exams. One of them would be, like, routine.
Now, it just so happens that if you look under “routine” there’s only one code that you’re going to find in the index under “routine” and this is it: routine, postpartum, follow-up, V24.2. I think that’s because it’s so common that people think of it as being routine; but there’s no other codes in your index listed under “routine” as a keyword.
But there’s like several, maybe two pages of several columns of ones for admission. The way they divide that up is its admission, and then “for” and then it indents into what’s the admission for – an exam. What are they getting the exam for? For fitting. And I picked “artificial eye” because my grandfather had an artificial eye, I thought that was interesting. V52.2 for that. They had prosthetics for an artificial limb.
Again, if you’re having trouble finding a code, the thing you need to do is be aware of what V codes allow you to tell in a story. Think statistical reasons as well, not just to get paid but then divide up, these are your major categories. Go to that section in your V codes. Now your index is going to be mixed in, like, the person had said, but you can open up to the V codes and just kind of flip through them and you’re going to see these major categories and find the codes that you maybe weren’t even aware of. If you do that, and I call that getting up close and friendly with your manual, it’s going to be really, really interesting what you’re going to find. Again, I think you’ll be surprised that some of the codes that are in there, you would have never thought that you could code for something like that, and it wouldn’t be there if it wasn’t needed.
That’s it for V codes. This is one little section of V codes, but we’ve done other slides on V codes in the past, but this is one that was a really good question.
Boyd: There was a comment that also said the main term “outcome of delivery” also links to V codes?
Alicia: Yes, that’s right – outcome of delivery. That’s right, that’s another big one.
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