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Reporting a V Code for Personal History

Homecare Insider, April 6, 2009

How and when should a homecare clinician report V codes for personal history?  The ICD-9-CM coding guidelines say that a personal history code “explains a past medical condition that no longer exists and is not receiving any treatment, but has the potential for recurrence, and therefore may require continued monitoring.”  These V codes tend to be most helpful for physicians, providing information about the patient’s past to help them plan appropriate treatment.  Two examples show when a V code is and isn’t helpful to support the homecare patient’s need for Medicare coverage.

Personal history code not needed
Homecare providers report diagnoses to support a plan of care for Medicare coverage.  Because the condition described by a personal history code no longer exists, Medicare would not recognize any related services to be reasonable and necessary.  Example:  The patient had surgery for lung cancer six months ago and is receiving another round of chemotherapy.  Cancer is part of this patient’s recent history; more importantly, it still exists and is receiving treatment.  The diagnosis of lung cancer (162.5), instead of personal history of cancer of lung cancer (V10.11), would be appropriate.  Also note:  The V code encounter for chemotherapy (V58.11) can serve only as the patient’s principal diagnosis.

Personal history code helps
Coding changes effective October 1, 2008, added some specific codes to the subclassification personal history of other diseases.  One code in particular, personal history of pathologic fracture (V13.51), is helpful for patients receiving nursing visits for administration of an osteoporosis injectable medication, either Calcitonin® or Forteo®.  To qualify for coverage of Calcitonin or Forteo, the patient must be postmenopausal and have sustained a fracture due to osteoporosis.  Example:  The patient broke her hip in December and was diagnosed with osteoporosis.  The physician ordered Calcitonin.  The patient finds it too difficult to leave home in the winter to get these injections.  Reporting postmenopausal osteoporosis (733.01) as the principal diagnosis and the personal history code of pathologic fracture as a pertinent diagnosis shows that the patient meets the criteria.  Since this condition no longer exists, it would be a low-priority diagnosis.  

The second day of Beacon Health’s Mastering Medicare seminar is all about diagnosis coding.  The next seminar will be in Nashville on April 20 and 21.

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