ICD-9: V72.83 and V10.05

V72.83 Frequently Won't Stand Alone

Question: Your surgeon carries out a pre-bypass surgery EGD and records acute esophagitis. What ICD-9 coding options should we list for the claim?

Answer: Since you must always report the most specific diagnosis, you must list the code for the esophagogastroduodenoscopy (EGD) findings: 530.12 (Acute esophagitis).

However you should also list ICD-9 coding options to demonstrate the reason for the EGD as a pre-op procedure for gastric bypass surgery. Submit the following listed codes to document the reason for the test:

• 278.01 -- Morbid obesity
• V85.xx -- Body mass index …
• V72.83 -- Other specified preoperative examination.

FYI: A lot of payers won't accept ICD-9 coding option V72.83 as primary diagnosis, thus reporting findings from the EGD is vital. In case no symptoms appear, listing obesity and BMI that demonstrate medical necessity for the bypass surgery serve to demonstrate medical necessity for the service.

153.3 Vs. V10.05 -- Get the History Right

Question: You have a patient who had a colon resection for cancer over six months ago. Two months after the surgery, he had a Mediport inserted for chemotherapy. The patient has accomplished the course of treatment and comes to your surgeon's office to talk over when to schedule the Medi-port removal as he is in remission. Your surgeon also examines the incisions from the initial resection as well as the Medi-port insertion. The surgeon then dictates the diagnosis for the service as "colon cancer" although he's scheduling the Medi-port removal as the colon cancer treatment is complete. Shouldn't the diagnosis be "history of colon cancer"?

Answer: You are right that in case all treatment directed toward the cancer is complete and there are no signs of current disease, you must use a history of cancer code in place of a cancer code.

Do this: Report the reason for the encounter as V10.05 (Personal history of malignant neoplasm of large intestine). You must not use the family history code (V16.0, Family history of malignant neoplasm of gastrointestinal tract).

You must not report the cancer diagnosis with the ICD9 coding option 153.3 (Malignant neoplasm of sigmoid colon) for this patient encounter.