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.