V and E Codes FAQ
1. What are V codes?
V codes (codes V01–V91) are used to describe encounters with circumstances other than disease or injury. V codes are used either as a first listed (primary) or contributing (secondary) code depending on the situation. There are four primary situations for which V codes are used:
1) A person who is not currently sick or injured encounters the healthcare system for a specific reason (e.g., exposure to an infectious disease).
2) A person with a resolving injury/disease or a chronic condition requires aftercare specifically for that condition (e.g., suture removal, dressing change).
3) Circumstances or problems influence a person's health status, but are not themselves a current illness or injury (e.g., asymptomatic HIV status).
4) Newborns, to indicate birth status.
2. Can V codes be used as a primary diagnosis?
Yes, unless otherwise specified in the code descriptor, V codes may be used as the primary diagnosis. Some V codes are required to be used as primary diagnosis, but only a few of these codes apply in the ED setting. (e.g. V70.4 Examination for medico-legal reasons, V71.x Observation and evaluation for suspected conditions not found).
Example: A patient comes to the ED after finding a bat in the tent while camping. There is no obvious injury. In this case the primary diagnosis would be V01.5 Contact with or exposure to rabies.
Example: You deliver a liveborn child in the ED and perform an MSE on the newborn. In this case the primary diagnosis would be V30.00 Single liveborn, Born in hospital, delivered without mention of cesarean delivery or V30.1 if delivered in the patient’s car in the parking lot.
A V code may only be used as a contributing (secondary) diagnosis when it has a “code first” note with the description. Many commercial ICD books may note some V codes are an “unacceptable primary diagnosis” or can be a "secondary diagnosis only." This notation only applies to these codes for their use as a primary inpatient diagnosis and does not affect their use in the outpatient setting.
3. Are there times when I can’t use a V code for a primary diagnosis?
Yes. This is payer dependent. For example, Medicare does not allow V codes as the primary diagnosis for Hospice claims.
4. Are V codes mandatory?
The Official Coding Guidelines do not differentiate the use of V codes from that of other codes (except E codes). V codes will most often be used to describe an encounter for testing or to identify a potential risk. They should not be used, however, when the diagnosis code includes the condition provided by the status/V code.
Example 1: A patient with a ventricular-peritoneal shunt present to the ED with a vomiting. After an appropriate evaluation it is determined that there is no shunt malfunction and that the vomiting was most likely due to a viral process. In this case the primary diagnosis would be 787.03 Vomiting. A secondary diagnosis of V45.2, presence of cerebrospinal fluid drainage device, would help support medical necessity for a workup to determine whether there was a shunt malfunction.
Example 2: A patient presents with complications associated with heart transplant. Code V42.1, Heart transplant status, should not be used with code 996.83, Complications of transplanted heart. The status code does not provide additional information. The complication code indicates that the patient is a heart transplant patient.
Additional V code information may be found in section I-18 of the 2011 Official ICD-9-CM Coding Guidelines; ( http://www.cdc.gov/nchs/data/icd9/icd9cm_guidelines_2011.pdf ).
5. What are some commonly used V codes in Emergency Medicine?
The following are some commonly used V codes in the ED and the situations in which they may be used.
1) V71.4 Observation following other accident – a patient presenting after a motor vehicle accident but is uninjured, has no complaints or physical findings.
2) V71.5 Observation following alleged rape or seduction – examination of either the victim or culprit for evidence collection without any physical findings.
3) V70.4 Examination for medico-legal reason - patient brought by law enforcement for blood-alcohol test or jail clearance.
4) V55.1 Attention to artificial openings, gastrostomy – a patient is sent from nursing home because G-tube has fallen out and needs replacing.
5) V62.84 Suicidal ideation.
6) V62.85 Homicidal ideation.
7) V22.2 Incidental pregnancy (not primary Dx).
8) V65.5 Person with feared complaint not found.
9) V71.3 Observation following accident at work – has no complaints or physical findings.
10) V71.89 Observation for other suspected conditions.
11) V72.41 Negative pregnancy test.
12) V72.42 Positive pregnancy test.
13) V15.81 Non-compliance with medical treatment (not primary Dx).
14) V15.85 Exposure to potentially hazardous body fluids.
15) V58.31 Encounter for change or removal of surgical wound dressing.
16) V58.32 Encounter for removal of sutures.
6. What are E codes?
E codes are supplemental codes that capture the external cause of injury or poisoning, the intent and the place where the event occurred. E codes are intended to provide data for injury research and prevention strategies. E codes are never to be used as a primary diagnosis code.
7. Are E codes mandatory?
Use of E codes is generally not mandatory; however, their use may be mandatory in certain institutions and/or states. Additional E code information by be found in the 2012 Official ICD-9-CM Coding Guideline.
Certain payers may deny your claim if you use V or E codes. Be sure to contact your payers to determine how they will process these codes. You may need to remind the payer that V codes are part of the HIPAA transaction code set and subject to the rules and advice found in Coding Guidelines for ICD-9-CM and ICD-9-CM Coding Clinic.
The American College of Emergency Physicians (ACEP) has developed the Reimbursement & Coding FAQs and Pearls for informational purposes only. The FAQs and Pearls have been developed by sources knowledgeable in their fields, reviewed by a committee, and are intended to describe current coding practice. However, ACEP cannot guarantee that the information contained in the FAQs and Pearls is in every respect accurate, complete, or up to date. The FAQs and Pearls are provided "as is" without warranty of any kind, either express or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. Payment policies can vary from payer to payer. ACEP, its committee members, authors or editors assume no responsibility for, and expressly disclaim liability for, damages of any kind arising out of or relating to any use, non-use, interpretation of, or reliance on information contained or not contained in the FAQs and Pearls. In no event shall ACEP be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Specific coding or payment related issues should be directed to the payer. For information about this FAQ/ Pearl, or to provide feedback, please contact David A. McKenzie, CAE, Reimbursement Director, ACEP at (972) 550-0911, Ext. 3233 or firstname.lastname@example.org.