Download medical coding - University of Utah School of Medicine

MEDICAL CODING
CDC Recommendations
In 2006 the Centers for Disease
Control and Prevention (CDC)
recommended routine HIV
screening for all individuals
between the ages of 1364 years, in all health care
settings, on an opt-out basis. *
It is estimated that 1 to 1.2
million people are living with
HIV/AIDS in the United States. As many as 25% of
these people are unaware they have HIV infection.
The transmission rate among those who do not
know they are infected is 3.5 times higher than for
people who know about their HIV infection.
Medicare HCPCS Codes
Test Product
Code
Description
G0432
Infectious agent antigen detection by enzyme immunoassay
(EIA) technique, qualitative or semi-quantitative, multiplestep method, HIV-1 or HIV-2, screening
G0433
Infectious agent antigen detection by enzyme-linked
immunosorbent assay (ELISA) technique, antibody, HIV-1 or
HIV-2, screening
G0435
Infectious agent antigen detection by rapid antibody test of
oral mucosa transudate, HIV-1 or HIV-2, screening
CPT Codes
Test Product
Code
Rapid Test
Modifier
86689
In 2009 the Utah Department of Health reported:
•112 new HIV cases; (5.7% increase from
106 cases reported in 2008)
Description
Antibody; HTLV or HIV antibody, confirmatory
test (e.g, Western Blot)
86701
92
Antibody; HIV-1
86703
92
Antibody; HIV-1 and HIV-2, single assay
87534
Infectious agent detection by nucleic acid
(DNA or RNA); HIV-1, direct probe technique
87535
Infectious agent detection by nucleic acid
(DNA or RNA); HIV-1, amplified probe
technique
•61% were between the ages of 20-39 (115)
87536
•38% were between the ages of 40-59 (71)
Infectious agent detection by nucleic acid
(DNA or RNA); HIV-1, quantification
87390
•77 new AIDS cases; (16.7% increase from
66 cases reported in 2008)
•1% were under the age of 20 (3)
Resulting in a total of 3,538 HIV/AIDS cases in the
state of Utah from 1983-2009.
Medical Referral Sites and Contacts
92
Infectious agent antigen detection by enzyme
immunoassay technique, qualitative or semiquantitative, multiple step method; HIV-1
Test Administration
Code
Description
36415
Collection of venous blood by venipuncture
Office Service
Code
Description
If you have a patient that tests
positive in your office please
contact Clinic 1A to set up an
appointment or to consult with
an HIV provider.
99385
Initial comprehensive preventive medicine service evaluation
and management 18–39 years of age (new patient)
99386
Initial comprehensive preventive medicine service evaluation
and management 40–64 years of age (new patient)
99395
Periodic comprehensive preventive medicine reevaluation
and management 18–39 years of age (established patient)
*Clinic 1A, University of Utah:
801-585-2031
99396
Periodic comprehensive preventive medicine reevaluation
and management 40–64 years of age (established patient)
9921199215
Office or other outpatient visit for the evaluation and
management of an established patient that may not require
the presence of a physician.
*Opt-out screening: performing and HIV test after notifying the patient that
the test will be done. Written consent or pre-test counseling is not required
beyond what is usually performed.
American Academy of HIV Medicine. Routine HIV testing: a toolkit for providers. [CD-ROM]
ICD-9-CM Diagnosis Codes
Situation
Code
Description
Patient seen as part of a routine
medical exam
V70.0
Routine general
medical examination
at a health care facility
Patient seen to determine his/
her HIV status (can be used
in addition to routine medical
exam)
V73.89
Special screening for
other specified viral
diseases
Asymptomatic patient in a
known high-risk group for HIV
(can be used in addition to
routine medical exam)
V69.8
Other problems
related to lifestyle
Counseling provided during
the encounter for the test (add
additional code if applicable)
V65.44
HIV counseling
Returning patient informed of
his/her HIV negative test results
V65.44
HIV counseling
Returning patient informed of
his/her HIV positive test results
AND patient is asymptomatic
V08
Asymptomatic HIV
infection status
Returning patient informed of
his/her HIV positive test results,
AND patient is symptomatic
042
HIV disease
HIV counseling provided to
patient with positive test results
V65.44
HIV counseling
Patient seen as part of prenatal
medical examination
V73.89
Patient seen as part
of a routine prenatal
care
Patient seen for first pregnancy
V22.0
Supervision of normal
first pregnancy
Patient seen for first pregnancy
Patient seen for other-than-first
pregnancy (second, third, etc.)
V22.1
Supervision of other
normal pregnancy
Management of high-risk
pregnancy
V23.8
Other High-Risk
Pregnancy
Management of high-risk
pregnancy
V23.9
Supervision of
unspecified high-risk
pregnancy
Additional Resources
*National HIV/AIDS Clinicians’
Consultation Center
http://www.nccc.ucsf.edu/
*National HIV Testing Resources
http://www.hivtest.org
*Utah AIDS Information Line
(800) 366-2437
*Utah AIDS Education and
Training Center
(801) 581-5310
*AIDS InfoNET
www.aidsinfonet.org/
*American Medical Association, CPT
www.ama-assn.org/go/cpt
*CDC HIV Website
http://www.cdc.gov/hiv/
*Mountain Plains AIDS Education
and Training Center
http://www.mpaetc.org
Risk Factors
References and Resources
Anyone of any age, race, sex or sexual
orientation can be infected with HIV. Many
people do not perceive themselves to be
at risk for HIV or may not disclose their
risks. The fastest growing method of HIV
transmission is heterosexual contact.
Centers for Disease Control and Prevention.
Revised Recommendations for HIV Testing of
Adults, Adolescents, and Pregnant Women in
Health-Care Settings. MMWR 2006; 55
(No. RR-14): 1-17
Major risk factors include:
•Unprotected sex with multiple partners
or someone who is HIV-positive.
•Having another sexually transmitted
disease, such as syphilis, herpes,
chlamydia, gonorrhea or bacterial
vaginosis.
•Sharing needles during intravenous
drug use.
•Having received a blood transfusion
or blood products before 1985.
Window Period
Most HIV tests are antibody tests that
measure the antibodies your body makes
against HIV. Most people will develop
detectable antibodies within 2 to 8 weeks
(the average is 25 days). Even so, there is
a chance that some individuals will take
longer to develop detectable antibodies.
Therefore, if the initial negative HIV test was
conducted within the first 3 months after
possible exposure, repeat testing should be
considered >3 months after the exposure
occurred to account for the possibility of
a false-negative result. 97% of persons will
develop antibodies in the first 3 months
following the time of their infection. In very
rare cases, it can take up to 6 months to
develop antibodies to HIV.
Centers for Disease Control and Prevention,
HIV Testing Basics for Consumers Website.
http://www.cdc.gov/hiv/topics/testing/
resources/qa/index.htm
Accessed March 15, 2011.
American Academy of HIV Medicine. The
basics of HIV screening and testing. Routine
HIV testing: a toolkit for providers. [CD-ROM]
Accessed March 10, 2011.
American Academy of HIV Medicine. Coding
guide for routine HIV testing in health care
settings. Routine HIV testing: a toolkit for
providers. [CD-ROM]
Accessed March 10, 2011.
Community Resources
Utah AIDS Foundation
www.utahaids.org
Utah Pride Center
www.utahpridecenter.org
Northern Utah Coalition
http://www.northernutahcoalition.com/
People with AIDS Coalition of Utah
http://www.pwacu.org/
To receive more education and information please contact:
Utah AIDS Education & Training Center - (801) 581-5310
30 N 1900 E Room 4B319 Salt Lake City, UT 84132
[email protected]
Routine
HIV Testing