Coding & Billing for HIV & STI Testing and Preventative ...

1 Coding & Billing for HIV & STIT esting and Preventative ServicesNovember 19, 2018 Presented byDr. Lisa L Campbell, PhD, MHA, MPHRHIA, CDIP, CCS, CCS-P, CPC, COC, CPC-ISpeaker Biography26 Years ExperienceMedical AssistantCertified Coding SpecialistMedical BillerEducatorHealthcare Administrator Health Information AdministratorClinical Documentation Improvement Specialist Consultant VolunteerDisclaimerThe information presented and responses to the questions posed are not intended to serve as Coding or legal advice. Many variables affect Coding decisions and any response to the limited information provided in a question is intended only to provide general information that might be considered in resolving Coding issues.

2 All Coding must be considered on a case-by-case basis and must be supported by appropriate documentation in the health , we recommend consulting directly with payers to determine specific payers guidance regarding appropriate Coding and claim submission. CPT Disclaimer CPT copyright 2018 American Medical Association The CPT codes that are utilized in Coding claims are produced and copyrighted by the American Medical Association (AMA). Specific questions regarding the use of CPT codes may be directed to the AMA. CPT is a registered trademark of the American Medical Association Objectives Understand how proper documentation and Coding supports compliant Billing practices and efficiencies.

3 Understand relevant ICD, CPT and modifier terminology and codes. Become familiar with common HIV/STI ICD codes. Apply knowledge learned by identifying which codes would be assigned to a patient Billing ProcessPaintPaint a picture of the visit by your documentationIdentifyIdentify all services you provided today CPT / HCPCS DiscussDiscuss why you performed the services ICD-10-CMIdentifyIdentify any special circumstances ModifiersFollowFollow established Coding rules and regulationsDocumentation BasicsImproves compliance Improves patient care Improves clinical data for research and education Protects the legal interest of the patient.

4 Facility and clinician Enables proper reimbursement for services performed If it isn t documented it can t be coded and ultimately billed!Documentation Basics Ensure your documentation supports the codes billed for services and captures the essential elements needed by your payers Be careful to not cut and paste documentation without individualizing the notes to the specific patient visit More is not better quality vs. quantity CPT/HCPCS CodesNew Patient Office Visit99201 Level I99202 Level II99203 Level III99204 Level IV99205 Level VHistoryProblem FocusedHPI(1-3) FocusedHPI(1-3)ROS (1)Detailed HPI(4+)ROS (2-9)PFSH (1-2)ComprehensiveHPI(4+)ROS (10+)PFSH (3)Comprehensive HPI(4+)ROS (10+)PFSH (3)ExamProblem FocusedBA/OS (1) FocusedBA/OS (2-4)DetailedBA/OS (5-7)ComprehensiveOS (8+)ComprehensiveOS (8+) Decision MakingStraightforwardStraightforwardLowM oderateHighEstablished Patient Office Visit99211 Level I99212 Level II99213 Level III99214 Level IV99215 Level VHistoryNurse VisitProblem FocusedHPI(1-3) FocusedHPI(1-3)ROS (1)

5 DetailedHPI(4+)ROS (2-9)PFSH (1)Comprehensive HPI(4+)ROS (10+)PFSH (2)ExamNurseVisitProblem FocusedBA/OS (1) FocusedBA/OS (2-4)DetailedBA/OS (5-7)ComprehensiveOS (8+) Decision MakingNurse VisitStraightforwardLowModerateHighPreve ntative Medicine, Individual Counseling Preventive medicine counselingand/or risk factor reduction intervention(s) provided to an individual (separate procedure); 99401 approximately 15 minutes 99402 approximately 30 minutes 99403 approximately 45 minutes 99404 approximately 60 minutesHIV screening -Non-Medicare PatientsCPT CodeDescriptor86701 HIV-186702 HIV-286703 HIV-1 and HIV-2, single result87389 HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single resultHIV screening -Medicare Part B HCPCS CodeDescriptorG0432 Infectious agent antibody detection by enzyme Immune assay (EIA) technique, qualitative or Semi-quantitative, multiple-step method, HIV-1 or HIV-2, screeningG0433 Infectious agent antibody detection by enzyme-linked immunosorbent assay (ELISA)

6 Technique, antibody, HIV-1 or HIV-2, screeningG0435 Infectious agent antibody detection by rapid antibody test of oral mucosa transudate, HIV-1 or HIV-2, screening -ChlamydiaCPT CodeDescriptor86631 Antibody; Chlamydia86632 Antibody; Chlamydia, IgM87110 Culture, chlamydia, any source87270 Infectious agent antigen detection by immunofluorescent technique; Chlamydia trachomatis87320 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Chlamydia trachomatisSTI screening -ChlamydiaCPT CodeDescriptor87490 Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, direct probe technique87491 Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique87800 Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique87810 Infectious agent antigen detection by immunoassay with direct optical observation; Chlamydia trachomatisSTI screening -GonorrheaCPT CodeDescriptor87590 Infectious agent detection by nucleic acid (DNA or RNA).

7 Neisseria gonorrhea, direct probe technique87591 Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhea, amplified probe technique87850 Infectious agent antigen detection by immunoassay with direct optical observation; Neisseria gonorrhea87800 Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) techniqueSTI screening -SyphilisCPT CodeDescriptor86592 Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART)86593 Syphilis test, non-treponemal antibody; quantitative86780 Antibody; Treponema pallidumSTI screening -Hepatitis BCPT CodeDescriptor87340 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg)87341 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method.

8 Hepatitis B surface antigen (HBsAg) neutralizationModifiersHIV screening Modifiers 33: Preventive Services:When the primary purpose of the service is the delivery of an evidence-based service in accordance with a US Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by adding 33 to the procedure. For separately reported services specifically identified as preventive, the modifier should not be : Alternative Laboratory Platform Testing :When laboratory Testing is being performed using a kit or transportable instrument that wholly or in part consists of a single use, disposable analytical chamber, the service may be identified by adding modifier 92 to the usual laboratory procedure code (HIV testing86701-86703, and87389).

9 The test does not require permanent dedicated space; hence by its design may be hand carried or transported to the vicinity of the patient for immediate Testing at that site, although location of the Testing is not in itself determinative of the use of this CodesDiagnosis mode of Transmission (other than HIV/HPV) viral Diagnosis Codes-Contact (Suspected) Exposure sexual mode of transmission Hepatitis viral communicable diseases hazardous body fluidsDiagnosis specified counselingDiagnosis Codes-HIVB20, human immunodeficiency virus (HIV) diseaseIncludes AIDS, ARC, or symptomatic HIV infectionZ21, Asymptomatic human immunodeficiency virus (HIV)

10 Infection statusNo HIV-related illnessR75, Inconclusive laboratory evidence of HIVI nconclusive HIV test findingDiagnosis Codes-HIV Related Illnesses Requires a minimum of two codesoCode B20 to identify the HIV diseaseoAdditional codes to identify all manifestations of HIV infection Diagnosis Codes-HIV-Related Illness in Pregnancy During pregnancy, childbirth, or puerperiumoCode firstoAdditional code to identify the type of HIV diseaseoB20 or Z71 Diagnosis CodesHIV-Related Illness and Unrelated Conditions When a patient with HIV disease is admitted for an unrelated condition, such as a traumatic injury or a disease that was not caused by the HIV diseaseoCode first the unrelated conditionoOther diagnoses would be B20 followed by additional diagnosis codes for all reportable HIV-related conditionsAsymptomatic HIV Infection Status Code Z21 is used when the patient has the HIV virus in the blood but does not have any documented symptoms of the infection Diagnosis may be HIV positive Code Z21 is not used if the patient is treated for any HIV-related illnessesDiagnosis Codes-STI Syphilis Syphilis infection (PID) infection (Anus and rectum)