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Report V codes under four primary circumstances

APCs Weekly Monitor, February 1, 2008

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QUESTION: If a patient presents to a hospital outpatient infusion department for a Neulasta® injection (code J2505), but had normally been receiving the chemotherapy in a physician's office, can the hospital report code V58.11 (chemotherapy) or V66.2 (convalescence care) after the patient receives the injection?

We are not a hospice-certified hospital, and we're not sure whether code V66.2 is applicable or whether code V58.69 would be more appropriate. Can you advise?

ANSWER: Per Coding Clinic, you can report V codes, including code V66.2, in any healthcare setting.

Report V codes either as primary diagnosis codes in an outpatient setting or as secondary codes in an inpatient setting, depending on the circumstances of the encounter.

You may only report certain V codes as "first listed," and others only as secondary codes. The following are four primary circumstances that warrant reporting V codes:

• A person who is not currently sick encounters services for a specific reason, such as to act as an organ donor, to receive prophylactic care (e.g., inoculations or health screenings), or to receive counseling on health-related issues.
• A person with a resolving disease or injury, or a chronic, long-term condition that requires continuous care, presents for specific aftercare of that disease or injury (e.g., dialysis for renal disease; chemotherapy for malignancy; cast change). Use a diagnosis/symptom code whenever the physician is treating a current and acute diagnosis, or whenever a physician is studying a sign or symptom.
• Circumstances or problems influence a person's health status but are not in themselves a current illness or injury.
• Newborns, to indicate birth status.

Check with your local FI regarding diagnosis code instructions for Neulasta®, as instructions vary from FI to FI.

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