Transcription of Recommended ICD-10-CM Codes Pre-Exposure Prophylaxis …
1 CodesPre- exposure Prophylaxis (PrEP) and Post- exposure Prophylaxis (PEP)The International Classification of Diseases, Tenth Revision, Clinical Modification ( ICD-10-CM ) coding system does not designate specific billing Codes for PrEP- or PEP-related services. The New York State Department of Health and the New York City Department of Health and Mental Hygiene recommend the use of the following ICD-10-CM Codes for PrEP- and PEP-related outpatient services. VISITS: All office visits must include a principal diagnosis/first-listed condition to be billable. , bolded below, is classified as an acceptable principal diagnosis in the ICD-10-CM system. Always include when coding PrEP or PEP visits. If an insurer requires additional coding clarifying a patient s risk, (sexual exposure risk) and (injection drug use exposure risk) can be added.
2 These Codes avoid the use of the Codes that are considered stigmatizingbecause they indicate problems related to lifestyle. TESTS: HIV, STI, HCV and other tests associated with PrEP and PEP are related to the patient s ongoing risk of infection, even if the patient is asymptomatic. Screening tests are ordered at initial visit. Subsequent visits use contact with Codes . Tests which are ordered to evaluate the patient for conditions potentially associated with long-term use of PrEP medication should include the code Codes Initial VisitCoding f or:ICD-10 CodeDescriptionVisit Z20 .6 Contact w it h and ( suspec ted) exposure t o HIVZ20 .2 Contac t wi th and (sus pe cte d) expo sure to i nf ec ti on s wi th a predomina nt ly sex ua l mod e of transmissionInitial Tests Z01.
3 812 Enc ounter f or pre-procedu ral laboratory examina ti on ( Applic abl e t o bl oo d an d urine tests prior to treatmen t o r procedure) ounter f or scree ni ng for inf ec ti ons with a predominan tl y sex ual mod e of tr an smissionZ11 .4 Enc ounter f or scree ni ng for human i mmun od ef icien cy vir us Z11 .59 Enc ounter f or scree ni ng for other vir al di sea ses*PrEP-Related Codes Secondand Subsequent VisitsCoding f or:ICD-10 CodeDescriptionVisit and Tests Z20 .6 Contact w it h and ( suspec ted) exposure t o HIVZ20 .2 Contac t wi th and (sus pe cte d) expo sure to i nf ec ti on s wi th a predomina nt ly sex ua l mod e of Otherlong-termdrug therapyZ20 .5 Contac t wi th and (sus pe cte d) expo sure to vir al hep at itis*PEP-Related Codes Initial and Subsequent VisitsCoding f or:ICD-10 CodeDescriptionVisit and Tes ts Z20.
4 6 Contact w it h and ( suspec ted) exposure t o HIVZ20 .2 Contac t wi th and (sus pe cte d) expo sure to i nf ec ti on s wi tha predomina ntl y s ex ual mod e of transmissionZ77 .21 Contac t wi th and (sus pe cte d) expo sure to potenti ally hazardou s b ody f lui ds Z20 .5 Contac t wi th and (sus pe cte d) expo sure to vir al h ep at itis*When ordering hepatitisC tests for patients insured through Medicare:Medicare cov ers annual hepati tis C screening onlyforhigh-riskindividuals A single, once-in-a-lifetime screening test is covered for individuals born from 1945 through 1965 whodo not meet the high-riskdefinition. Per Medicare guidance, the initial encounter/test requisition for hepatitis C tests must includediagnosis (Other problems relatedto lifestyle).
5 Follow-up encounters/tests for annual hepatitis C testing should include diagnosis Codes (Unspecifieddrug dependence).Consult Medicare guidancedocumentsforspecific billing details.
