Zika Diagnosis Must Be Confirmed

Zika Diagnosis Must Be Confirmed

In the inpatient setting (but not the outpatient setting), you typically may report a diagnosis documented by the provider as “suspected,” “rule out,” “probable,” “possible,” etc. Exceptions to this rule include HIV and Zika. The ICD-10-CM Official Guidelines for Coding and Reporting (18.C.1.f) instruct:

Code only a confirmed diagnosis of Zika virus (A92.5, Zika virus disease) as documented by the provider. This is an exception to the hospital inpatient guideline Section II, H.  In this context, “confirmation” does not require documentation of the type of test performed; the physician’s diagnostic statement that the condition is confirmed is sufficient. This code should be assigned regardless of the stated mode of transmission.

The instructions tell us that if the provider documents “suspected,” “possible,” or “probable” Zika, you should not assign A92.5, and instead assign a code(s) that explain the reason for encounter (e.g., fever, rash, joint pain), or Z20.828 Contact with and (suspected) exposure to other viral communicable diseases.

John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

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John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

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