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Learn About Coding for HIV Screening on This HIV Testing Day

by | Jun 27, 2019 | Resources, Medical Coding News | 0 comments

Observed since June 27, 1995, National HIV Testing Day (NHTD) encourages people to get tested for HIV, know their status, and get linked to care and treatment. For 2019, the theme for this day is “Doing It My Way”. Human Immunodeficiency Virus or HIV is a retrovirus that weakens the human immune system, making people much more susceptible to infections and diseases. To document HIV treatments in medical claims, physicians can rely on medical billing services provided by professional companies. Medical coders in such companies will be up to date with the changing billing and coding standards.

Though HIV testing is recommended as part of routine health care, many Americans are not being tested as advised. Based on CDC reports, about 1.1 million people in the United States have HIV and one in seven of them are not aware of it. CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care.

HIV testing day is also the perfect time to offer support to people who have HIV and fight HIV stigma.

HIV Screening and Medicine

HIV screening involves blood test to check for the presence of HIV antibodies. These disease-fighting proteins react to HIV specifically and when present, indicate active infection. Though there’s no cure for HIV/AIDS, many different drugs are available to control the virus. For those with HIV, it is critical to take HIV medicine as prescribed by your doctor. HIV medicine lowers the amount of virus (viral load) in your body, and taking it every day can make your viral load undetectable. Antiretroviral therapy is an early treatment that significantly reduces the risk of developing acquired immunodeficiency syndrome (AIDS), which is the final stage of HIV infection.

To reduce the risk of getting HIV, it is recommended to limit the number of sex partners, get tested and treated for other sexually transmitted diseases and never share syringes or other equipment to inject drugs.

Medicare Coverage

Medicare covers annual HIV screenings for certain Medicare beneficiaries, who-

  • Are at age 15-65
  • Are younger than 15 or older than 65 and are at an increased risk for HIV
  • Are pregnant (you can get the screening up to 3 times during your pregnancy)

For accurate reimbursement for HIV screening, medical claims must include the correct codes.

Codes for HIV screening include

HCPCS Level II/CPT Codes

  • G0432 Infectious agent antibody detection by enzyme Immune assay (EIA) technique, qualitative or
    Semi-quantitative, multiple-step method, HIV-1 or HIV-2, screening
  • G0433 Infectious agent antibody detection by enzyme-linked immunosorbent assay (ELISA) technique, antibody,
    HIV-1 or HIV-2, screening
  • G0435 Infectious agent antibody detection by rapid antibody test of oral mucosal transudate, HIV-1 or HIV-2, screening
  • G0475 HIV antigen/antibody, combination assay, screening
  • 80081 Obstetric panel (includes HIV testing)

ICD-10-CM Codes

  • Z11.4 Encounter for screening for human immunodeficiency virus [HIV]
  • Z72.51 High risk heterosexual behavior
  • Z72.89 Other problems related to lifestyle
  • Z34.00 Encounter for supervision of normal first pregnancy, unspecified trimester
    • Z34.01 – first trimester
    • Z34.02 – second trimester
    • Z34.03 – third trimester
  • Z34.80 Encounter for supervision of other normal pregnancy, unspecified trimester
    • Z34.81 – first trimester
    • Z34.82 – second trimester
    • Z34.83 – third trimester
  • Z34.90 Encounter for supervision of normal pregnancy, unspecified, unspecified trimester
    • Z34.91 – first trimester
    • Z34.92 – second trimester
    • Z34.93 – third trimester
  • O09.90 Supervision of high risk pregnancy, unspecified, unspecified trimester
    • O09.91 – first trimester
    • O09.92 – second trimester
    • O09.93 – third trimester

Coders must make sure to submit HCPCS Level II codes such as G0475, G0432, G0433, and G0435 along with the required HIV primary diagnosis code Z11.4.

Early diagnosis is key to the successful treatment of HIV. It helps to improve the health of the patients and decrease transmission of the virus. While focusing on diagnosing and treating HIV, the services provided by an experienced medical billing company will be of great assistance for physicians.

Join hands to help spread awareness of the importance of HIV screening on this national HIV testing day.

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