Key ideas regarding V codes - taken from the transcript of the Nov. 2012 Q &A Webinar…
"How do I know when I need to use a V code?”
Alicia: The V codes, you have to think about them as… if you’re thinking of a painting… this what I used to tell my students that you’re painting a picture for the insurance company to explain what’s wrong with that patient.
The reason you’re going to use a V code is to explain why a patient’s being seen other than for an injury or disease. Okay, so it’s almost like it’s the background behind why the patient’s being seen.
There are 4 main categories for V codes:
1 - the person’s not sick but is being seen.
2 - resolving a disease, injury, or chronic long term condition.
3 -history pertinent to care
4 - newborn birth status.
Examples:
#1: patient seen today for a varicella vaccination, V05.4. So the person’s not sick but they’re being seen. So to explain why they’re being seen when they’re not sick or injured, you have a V code. They’re getting a vaccination.
#2 : X-ray reveals right lobe pneumonia. Patient is ventilator-dependent, V46.11. Okay now the person is sick, but what’s pertinent is this person is on a ventilator. And if this person’s on a ventilator, that’s pertinent to the care of that patient because now they have pneumonia. It’s the background behind what’s happening with that patient.
#3: An order given for glucose tolerance test. A patient has family history of diabetes, V18.0. Okay, well, just because the patient has some symptoms of diabetes may not be enough to justify going in and having a glucose tolerance test. But, if you tell the insurance company that there’s a family history of diabetes, V18.0, then there’s no question, whatsoever. It’s pertinent to the care of the patient.
#4: male infant born in ambulance in route to hospital. Okay, V30.1. Whenever a baby’s born, you got to tell what the status of that baby was born, whether they were born alive, stillborn, how many babies were born at one time. It’s usually V30.0 which is born in the hospital and V30.1 is born outside of the hospital.
Special things to know about V codes:
1.They’re used both for inpatient and outpatient settings, but more often they used for outpatient.
2.They can be listed as primary or secondary codes unlike E codes. V codes, especially like with vaccinations and stuff, they’re first listed.
3.To look up a V code, you use the alphabetical index just like you do with other codes.
4.What you need to do is be very familiar with the different categories of V codes.
