Billing with V Codes

Humana Military and PGBA remind you that it is especially important to use the proper V codes (when applicable) for claims reimbursement. A V code may designate a primary diagnosis for an outpatient claim that explains the reason for a patient’s visit to your office. V codes should be used for preventive or other screening claims; all other claims should be billed with the standard numeric ICD-9 diagnosis codes. Note: TRICARE policy defines V-code diagnoses as “conditions not attributable to a mental disorder.” Therefore, V-code diagnoses for TRICARE behavioral health care services are not covered.

Be sure to use the correct V-code diagnosis to indicate the reason for the visit. The V code must match the CPT code to indicate the procedure that you are performing as it correlates to the V-code diagnosis.

V codes correspond to descriptive, generic, preventive, ancillary, or required medical services, and should be billed accordingly.

For V codes that provide descriptive information as the reason for the patient visit, you may designate that description as the primary diagnosis. An example of a descriptive V code includes a routine infant or child health visit, which is designated as V20.2.

For generic non-payable services, such as lab, radiology, or preop, you should not use a generic V code as a primary diagnosis. Rather, you should list the underlying medical condition as the primary diagnosis for these ancillary services.

For preventive services, a V code that describes a personal or family history of a medical condition is sufficient as a primary diagnosis without the need for additional diagnostic information. Examples are a mammography, a Pap smear, or a fecal occult blood screening.