Author Topic: V58.69 and Long Term us of Plaqunil  (Read 5057 times)

davhafstehow

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V58.69 and Long Term us of Plaqunil
« on: April 12, 2011, 05:56:34 PM »
I have a patient who was seen because of long term use of Plaqunil.  I coded the diagnosis code of V58.69.  However it denied.  I realize many insurance co. do not recognize this code as a payable code.  I stumbled upon a code (V58.83) which says it is a billable medical code that can be used to specify a diagnosis on a reimbursement claim.  It says to use an additional code for any associated long-term (current) drug use.  The V58.83 code is defined as an 'Encounter for therapeutic drug monitoring'.  However, I cannot find this specific code in the ICD9CM.  Is this a legit code and will it work to use V58.83 as primary and V58.69 as secondary?  Or would it be better to use the code for Lupus and then the V58.69?  Not sure what to do?!?!  We are an optometric practice and the long-term use of Plaqunil is a concern for the eyes.

Thanks,
Tanya

Michele

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Re: V58.69 and Long Term us of Plaqunil
« Reply #1 on: April 13, 2011, 11:46:01 AM »
I feel like I should wear a T-Shirt  "Not A Coder...but" 

Anyway, isn't the long term use of plaqunil actually a secondary dx (or third or fourth) to the symptoms or diseases caused by the long term use?  What I mean is did the long term use result in blurred vision, headaches, floaters, glaucoma (grasping at straws!!!) etc??  So the primary diagnoses for the visit would be the symptoms the patient is having because of the long term use and then the long term use dx last as the cause of all of the other issues.

For example, if you step on a rusty nail the primary dx is open wound foot and the secondary dx is stepped on rusty nail.

Anybody else??
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pattil88

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Re: V58.69 and Long Term us of Plaqunil
« Reply #2 on: April 13, 2011, 09:23:20 PM »
Yes, Michele, I think you hit the nail on the head. (pun intended!)  In my ICD-9 book (published by Ingenix) V58.69 has a little red box to the right of the code with "SDx", indicating this should only be used as a secondary diagnosis. I rarely use a "V" code as a primary dx. unless the patient is presenting for services such as a wellness visit, healthchecks, physical exams, etc. - something in which there are no other symptoms or chief complaints. 

DMK

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Re: V58.69 and Long Term us of Plaqunil
« Reply #3 on: April 14, 2011, 11:20:32 AM »
I feel like I should wear a T-Shirt  "Not A Coder...but" 

Anyway, isn't the long term use of plaqunil actually a secondary dx (or third or fourth) to the symptoms or diseases caused by the long term use?  What I mean is did the long term use result in blurred vision, headaches, floaters, glaucoma (grasping at straws!!!) etc??  So the primary diagnoses for the visit would be the symptoms the patient is having because of the long term use and then the long term use dx last as the cause of all of the other issues.

For example, if you step on a rusty nail the primary dx is open wound foot and the secondary dx is stepped on rusty nail.

Anybody else??

Excellent example, always code what "the patient complains of" or "presents with" first , then "caused by" after.

TxJFP

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Re: V58.69 and Long Term us of Plaqunil
« Reply #4 on: May 05, 2011, 08:56:22 PM »
After further reading, V58.61 - V58.69 can only be used as a secondary DX. However, billing with V58.83 (first) then (V58.61-V58.69) is second. V code rule is to never be primary unless otherwise specified.


Good Luck! :)

Jesse

PMRNC

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Re: V58.69 and Long Term us of Plaqunil
« Reply #5 on: May 06, 2011, 02:34:22 PM »
I have to agree.. "Long term use..." technically isn't a diagnosis. I have long term use of Advil.. doesn't mean there's anything wrong with me (debatable) ::)
Linda Walker
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