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.

2 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. 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.

3 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 .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.

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 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 .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.

5 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).

6 Follow-up encounters/tests for annual hepatitis C testing should include diagnosis Codes (Unspecifieddrug dependence).Consult Medicare guidancedocumentsforspecific billing details.