V codes as supplemental diagnostic classifications in cancer chemotherapy

¶ … Icd-9-Cm V Codes

V Codes

V codes are provided as supplemental categories under the ICD-9-CM classification system (Ingenix Staff, 2010). They are intended to be used for situations when the patient seeks care for something other than a disease or injury, repetitive care related to a chronic or resolving disease or condition, follow up care after disease or condition has been successfully treated, or for providing relevant information that may have an impact on care trajectory. The information that V codes provide are critical because they can be used to justify medical treatments or denial of care, and elaborate on a disease condition.

Sequencing V Codes

V code use is controlled by the ICD-9-CM guidelines concerning how codes should be sequenced. An underlying condition should be listed first and any manifestations, late effects, or elaborations of the underlying condition listed next (Centers for Medicare & Medicaid Services [CMS] and National Center for Health Statistics, 2008, p. 3-4). An example of an exception to this rule is when the patient receives rehabilitative care (V57xx), with the underlying condition used to justify rehabilitative care sequenced second. Generally speaking though, V codes tend to be used for outpatient services.

V Code's Share of Medicare Reimbursement

The importance of V codes in terms of reimbursement can't be understated. For example, of the 126.7 billion dollars paid out for claims under Medicare, 25.5 billion or 20% was for care in skilled nursing facilities (Leonard, 2011). Of the skilled nursing facility claims, 30% of these claims, or 7.7 billion dollars, were reimbursed using V01-V86 codes. Total Medicare reimbursement for impatient care in 2009 was approximately 43.8 billion dollars and the amount recovered using codes V01-V86 represented 13% or 5.4 billion dollars. Of the 19.7 billion dollars paid out under Medicare for non-institutional outpatient care, 4.0% or close to 800 million represented claims using V01-V86 codes. V code claims therefore represent a big slice of the Medicare reimbursement pie.

Examples of When V Codes Should be used

If a patient seeks medical care under the belief that they've been exposed to rabies, possibly because they were bitten by a mangy dog, the treating physician may decide to treat the patient for rabies prophylactically using the rabies vaccine. The appropriate code for explaining why the patient sought care is V015 and the code for treating the patient would be V045 (CMS, 2011). In contrast, if a patient is exposed to rabies and fails to seek medical care until they begin to develop symptoms then code 071 (rabies) would be used to represent why the patient sought medical care. V codes therefore provide a means to reclaim costs associated with office visit and any prophylactic treatments when an underlying disease does not exist.