Medical Coding for AIDS Screening and Counseling

by | Published on Mar 14, 2016 | Medical Coding

Medical Coding Aids
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Medical coding for HIV screening is one of the most important medical billing and coding services offered by reliable medical outsourcing providers. When the CDC estimates that over 1.2 billion individuals in the United States are living with HIV infection with 1 in 8 among them totally unaware of their condition, it doesn’t take long to realize why AIDS prevention must be top priority.

Most serious health conditions are better prevented than treated, and that is highly relevant for dreaded infectious diseases such as AIDS where it does pay for individuals at high risk to take preventive measures to keep themselves, and the people they associate with safe.

Suspecting Exposure to HIV Risk

People usually visit their doctor for AIDS screening when they believe they have been exposed to a risk.

  • Z20.6 is the ICD-10 billable code for the patient having had contact with, and being suspected of having had exposure to, HIV
  • Z20.828 is the billable code for the patient having had contact with or suspected exposure to other communicable viral diseases

HIV exposure could be having sex with an HIV-infected individual without a condom, or a healthcare worker getting exposed accidentally. Individuals who are active sexually are at particular risk if they fail to use condoms.

  • Z72.51 signifies high risk heterosexual behavior

Depending on the kind of risk determined by the doctor, the patient must be screened for HIV. The results of the screening could be classified as follows, if the presence of HIV has not been clearly ruled:

  • R75 depicts inconclusive HIV laboratory evidence

Preventive Counseling

In such situations the next step would involve important counseling to ensure the individual takes the required measures to be safe. Sexually active adults need to take particular care.

  • Z71.7 signifies HIV counseling

The CPT codes for prevention counseling are as follows:

  • 99401: Counseling lasting 15 minutes
  • 99402: Counseling lasting 30 minutes
  • 99403: Counseling for 45 minutes
  • 99404: Counseling lasting 60 minutes

PrEP Preventive Medication

AIDS does have a preventive measure, and doctors are required to advise their patients about it at this stage. For individuals who do not have HIV but are in a high risk situation of contracting it, PrEP (Pre-Exposure Prophylaxis) is an effective preventive measure that involves taking a tenofovir disoproxil fumarate plus emtricitabine (TDF/FTC) combination medicine each day. High risk individuals are usually adults who are sexually active. The PrEP medication must be taken along with the other prevention options including the use of condoms during oral, anal and vaginal sex.

PEP and the Asymptomatic Stage

If the individual has had possible HIV exposure, they can still reduce the risk of being infected with HIV by using post-exposure prophylaxis (PEP) which must begin within 3 days of the person being possibly exposed to HIV.

  • Z21 depicts asymptomatic HIV infection status

As you know, the asymptomatic stage is when the HIV virus has already infected the person but the individual feels no effects of it and resembles a healthy individual. This stage could last as much as 10 years, and it is important that treatment begins at this stage so that the immune system does not get destroyed further and opportunistic infections (OI) begin to strike.

False Positive for Newborns

HIV-infected pregnant women need to be under HIV medication during the period of pregnancy and childbirth to bring down the risk of their babies contracting it. Newborn babies of HIV+ mothers are often diagnosed with the infection. They are therefore given AIDS medication for 6 weeks following their birth, which helps them reduce risk from HIV that might have entered their body during childbirth. For up to 18 months the diagnosis for the babies could return positive for AIDS, a false positive, without them actually becoming infected, thanks to their mothers’ antibody status.

Preventing someone from contracting this deadly and slow killing disease is a responsibility that lifts the medical profession to a noble vocation.

For healthcare practices to ensure they are reimbursed for the valuable services they render, accurate medical coding is important with respect to the individual’s health condition, test results and insurance coverage plan.

With professional and outsourced medical coding services, healthcare providers can fully focus on providing care and administering lifesaving prevention measures.

Meghann Drella

Meghann Drella possesses a profound understanding of ICD-10-CM and CPT requirements and procedures, actively participating in continuing education to stay abreast of any industry changes.

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