Pathology/Lab Coding Alert

Distinguish symptoms versus infection.

From ICD-10 to CMS to the Food and Drug Administration (FDA), official updates are changing how and when you perform and report Zika laboratory testing.

For a solid discussion of Zika lab methods and CPT® code options, you can still refer to “Look Ahead to CDC and Commercial-Lab Zika Testing,” in Pathology/Lab Coding Alert Vol. 17 No. 8. But you need to keep reading if you want to master the diagnosis, medical necessity, and public health ramifications of the expanding Zika outbreak.

Follow Coverage Rules

CMS established through MLN Matters SE1615, that it will provide coverage under Medicare Part B when patients are tested for the Zika virus to aid in the diagnosis and treatment of illness. The article delegates billing specifics to local Medicare Administrative Contractors (MACs).

Provide cost data: When billing MACs for Zika tests that your lab performs, you should provide resource and cost information so that the MACs can establish payment rates for the tests.

Clinician assigns diagnosis: Although the labs are likely doing the actual billing for the diagnostic testing, physicians and their coders need to provide the diagnosis codes to justify the medical necessity of the test, says, Sarah Todt, RN, CPMA, CPC, CEDC, Director or Provider Education & Audit for LogixHealth, a national coding and billing company in, Bedford, MA.

Understand indications: Although the Zika virus is known to spread primarily through infected Aedes species mosquitoes, it has also been established to spread by other modes of transmission, such as blood transfusions, from the mother to child, and through sexual activity. That’s why diverse conditions might indicate the need for a Zika test, from travel to a location with active mosquito vectors, to symptoms such as fever and joint pain, to possible virus exposure through other means such as sexual relations or blood transfusion.

Zika infection is of great concern for pregnant women who may spread the infection to the unborn child, possibly resulting in severe birth defects. The Centers for Disease Control and Prevention (CDC) issued an Oct. 19 update related to local Zika transmission in Florida. “Zika continues to pose a threat to pregnant women living in or traveling to Miami-Dade County,” said Lyle Petersen, MD, MPH, director, Division of Vector-Borne Diseases in the CDC update.

Focus ICD-10 on Reason for Test Plus Findings

If the ordering clinician indicates that he’s ordering a Zika test because the patient exhibits symptoms such as fever, headache, and joint pain, you should code the symptoms as the reason for the test, using codes such as the following:

• R50.9 (Fever, unspecified)
• M25.50 (Pain in unspecified joint)
• R51 (Headache)

But if the ordering clinician indicates that the test is for an asymptomatic patient with a recent history of travel to a Zika prevalent location, or sexual contact with a person who has traveled to a Zika prevalent zone, report Z11.59 (Encounter for screening for other viral diseases).

If the clinician orders a screening test for a patient who has had sexual contact with a Zika-infected person, you should consider reporting the encounter with Z20.828 (Contact with and [suspected] exposure to other viral communicable diseases).

Confirmed diagnosis: For a test result that confirms infection with the Zika virus, report new ICD-10 code A92.5 (Zika virus disease). Prior to Oct. 1 your only code choice for this diagnosis was A92.8 (Other specified mosquito-borne viral fevers), But ICD-10 2017 adds the new code for Zika infection.

Pregnancy is different: If the patient diagnosed with a Zika infection is pregnant, you should list first O98.51- (Other viral diseases complicating pregnancy...), with the sixth character identifying trimester.

Report findings: Don’t forget that the CDC has identified Zika virus disease as a “nationally notifiable condition,” which means that you should report suspected Zika virus disease cases to state, local, or territorial health department to facilitate diagnosis and mitigate risk of local transmission. State, local, and territorial health departments should report laboratory-confirmed and probable cases to CDC.

Update Blood Bank Testing Rules

Following a period of donated-blood testing only in areas of confirmed Zika virus transmission, the FDA recently revised guidance “recommending universal testing of donated whole blood and blood components for Zika virus in the U.S. and its territories.”

“There is still much uncertainty regarding the nature and extent of Zika virus transmission,” said Peter Marks, MD, PhD, director of the FDA’s Center for Biologics Evaluation and Research (CBER) in an Aug. 26 press release. “At this time, the recommendation for testing the entire blood supply will help ensure that safe blood is available for all individuals who might need transfusion.”

“As new scientific and epidemiological information regarding Zika virus has become available, it’s clear that additional precautionary measures are necessary,” said Luciana Borio, MD, the FDA’s acting chief scientist in the press release. “We are issuing revised guidance for immediate implementation in order to help maintain the safety of the U.S. blood supply.”

Blood banks currently test donations for other infectious blood-borne organisms, such as HIV, hepatitis, and West Nile virus.

Resources: You can access the MLN Matters coverage statement at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1615.pdf, and follow current CDC guidance regarding the Zika outbreak at http://www.cdc.gov/zika/index.html.