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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