V codes in ICD-9-CM coding and Medicare reimbursement

¶ … 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.

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.

Obesity is an underlying condition that increases the risk of developing comorbid conditions, such as diabetes and heart disease (Kushner and Blatner, 2005). The code for obesity, unspecified, is 27800 (CMS, 2011). Should the patient be morbidly obese then the appropriate code would be 27801. A substantial body of scientific evidence supports the need to be more specific concerning the level of obesity a patient may be suffering from, because the degree of risk for developing comorbid conditions depends significantly on how obese a patient is as measured by the body mass index (BMI). Accordingly, codes V850 through V8554 provide detailed information regarding a patient's degree of obesity in terms of BMI and therefore the chances that an obese patient will develop diabetes or cardiovascular disease.