V49.8x Increases Status Options


Report V49.8x for DNR, Physical Restraints

Every four to six months following the dysplasia treatment, your physician may see patients who have had vaginal or vulva dysplasia to verify that there has been no recurrence. This history may be the sole reason for the encounter. Currently, there was no way to report this.

Personal history codes can also help support testing. But you can now, see these with ICD-9 2011 code report personal history of vaginal and vulva dysplasia with V13 codes.

There's also a new ICD-9 code to indicate and do not resuscitate order. The two new V-codes capture status of a patient. The diagnoses are important to physicians who see patients in an inpatient or nursing home setting.

You use V49.86 for the DNR order, V49.87 to indicate that a patient needed restraining. Some additional V-codes that you may use include extension of the body mass index codes to demonstrate higher BMIs.

In the past, you had just one V-code to represent a BMI index over 40, that was the V85.4 lump sump large code. But the new edition of ICD-9 provides additional sub-classifications ranging from a BMI of 40.0 to 44.9 which is a V85.41 code through a BMI of 70 and over which goes to V85.45.

The new V85.4X ICD-9 codes will allow for better tracking of heavier individuals. The previous high BMI did not account for individuals over 60 tall and over 300 pounds. The new BMI codes will also help to support the need for weight management treatment.

Realize that official healthcare guidelines state that BMI can be coded based on clinical assessment. However, obesity must be documented by the physician before you can list the code for it.

For example, a new patient with the BMI of 45 presents to a FP complaining of shortness of breath and related symptoms. The FP determines that all of the symptoms are related to the patient’s morbid obesity and proceeds to counsel the patient on options for addressing his weight.

In this case, you would code the encounter with the primary diagnosis of 278.1 to represent the cause of the patient’s problems and V85.42 to specify the BMI and extend of the morbid obesity. The BMI codes are always secondary diagnosis.

The Department of Defence requested these codes V90 to help identify retained objects resulting from explosion injuries. But the codes could prove useful in other cases as well. For example, an embedded magnetic object which is now V9.11 is a contraindication to an MRI exam.

A physician may evaluate an embedded object and decides to leave in place as removal would be too complex or contraindicated. For instance, a child may have a small plastic piece in her chin that the FP evaluates and decides not to remove.

Effective with ICD-9 2011 codes, you can indicate that the foreign body was retained or embedded. This list indicates various fragment codes that you may want to either squeeze onto your super bill or list with the V9D.9 code so that the information could be filled in specifically on an as needed basis. FPs might use ICD-9 codes to retain fragments of wood is your V90.33 code, the plastic as in the child example of the embedded plastic piece in the chin would be V90.2.

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