Primary Care Coding Alert

Question: If an asymptomatic patient reports a concern that she might have a sexually transmitted disease and wants to be tested, which diagnosis code can the physician report that describes the situation and indicates medical necessity for the test?

Texas Subscriber

Answer: If the patient has been exposed to someone with a known disease, you should code the diagnosis as V01.6 (Contact with or exposure to venereal diseases). If the patient has no confirmed exposure, report V74.5 (Special screening examination for bacterial and spirochetal diseases; venereal disease).

Some payers will cover a lab test such as 86592 (Syphilis test; qualitative [e.g., VDRL, RPR, ART]) based on code V01.6, but not V74.5. If the family physician reports V74.5 because the patient has no symptoms or complaint of known exposure, he should obtain a signed advance beneficiary notice (ABN) indicating that the payer may deny payment for the lab test, and the lab will bill the patient directly for the test.