Pathology/Lab Coding Alert

Question: We're trying to bill Medicare for HIV screening -- what diagnosis code should we use?

Answer: Several different diagnosis codes would be appropriate, depending on the patient circumstances. For all Medicare HIV screening billing, you should report an ICD-9 "V" code, as opposed to a code for signs or symptoms of disease.

If the screening is for a patient with no increased risk factors or medical complications such as pregnancy, you should use V73.89 (Special screening for other specified viral diseases).

If the patient reports increased risk factors, such as past or present injection drug use, you should list V73.89 as the primary code and additionally report V69.8 (Other problems related to lifestyle) as the secondary diagnosis.

If the patient is pregnant, you can report an HIV screening at three specific times associated with the pregnancy: when the pregnancy diagnosis is known, during the third trimester, and at labor. For these HIV tests screenings during pregnancy, you should report V73.89, plus you should select the appropriate ICD-9 code from the following list based on the specific patient situation:

• V22.0 -- Supervision of normal first pregnancy
• V22.1 -- Supervision of other normal pregnancy
• V23.9 -- Supervision of unspecified high-risk pregnancy.

Using one of these codes as a secondary diagnosis will allow you to bypass the HIV screening frequency restriction of once per year.