What Diagnosis Code to Use While Billing Medicare For Hiv Screening

If you are confused about which ICD-9 code to use while billing Medicare for HIV screening, read on and get to know the right answer:

Various diagnosis codes would be right here, depending on the patient circumstances. For all Medicare HIV screening billing, you should go for an ICD-9 "V" code as opposed to a code for signs or symptoms of disease.

If the screening is for a patient with no increased risk factors or medical complications such as pregnancy, you should report V73.89 (Special screening for other specified viral diseases).

If the patient reports increased risk factors such as past or present injection drug use, you should list V73.89 as the primary code and additionally report V69.8 (Other problems related to lifestyle) as the secondary diagnosis.

If the patient is pregnant, you can go for an HIV screening at three specific times associated with the pregnancy: when the pregnancy diagnosis is known during the third trimester, and at labor. For these HIV tests screenings during pregnancy, you should go for V73.89; in addition you should choose the proper ICD-9 code from the following list based on the specific patient situation:

V22.0 -- Supervision of normal first pregnancy

V22.1 -- Supervision of other normal pregnancy

V23.9 -- Supervision of unspecified high-risk pregnancy.

Reporting one of these codes as a secondary diagnosis will allow you to bypass the HIV screening frequency restriction of once a year.

Do 569.3 and 578.1 function the same way?

As a just-in gastroenterologist coder, sometimes you may run into rough weather or be confused about which code to use for a particular service.

For instance, a just-in coder was confused about when to use 569.3 and 578.1 for bloody stool? She was trying to figure out if they are one and the same.

Well, the answer is no. When you examine the stool, you would be able to decide on the original source of the bleeding. After that you would be able to select the proper ICD-9 code.

Blood in the stool originates from somewhere up the gastrointestinal tract. In this situation, you would use 578.1 (Blood in stool). On the contrary, traces of bright red blood on the outside of the stool or on the toilet tissue normally takes place from a source within the rectum or anus (569.3, Hemorrhage of rectum and anus).

While coding for a colonoscopy (45378), you would normally report 578.1 with 792.1 (Nonspecific abnormal findings in stool contents). A number of carriers do not accept rectal bleeding as a justifiable diagnosis for colonoscopy as they presume that the source of the bleeding is the rectum or anus, not the colon. But then, they accept rectal bleeding as an acceptable diagnosis for a flexible sigmoidoscopy (45330, Sigmoidoscopy, flexible; diagnostic, with or with no collection of specimen[s] by brushing or washing [separate procedure]).

Here's a hint: The gastroenterologist would opt for a colonoscopy if the flexible sigmoidoscopy does not reveal a source of the bleeding. The source could lie past the splenic flexure, which is only visible through a colonoscopy.

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