Ob-Gyn Coding Alert

Don’t miss this ICD-10 symptoms and diagnosis coding refresher.

As concerns about the Zika virus spread in the United States, you may see more patients in your ob-gyn practice wanting to be tested, and here are the requirements you must meet to bill CMS.

In a special edition article of MLN Matters, Number: SE1615 Related Change Request, CMS announced that Zika virus testing is covered under Medicare Part B as long as the clinical diagnostic laboratory test is reasonable and necessary for the diagnosis or treatment of a person’s illness or injury.

According to the Centers for Disease Control and Prevention (CDC), the Zika virus disease is a nationally notifiable condition that has caused outbreaks in many countries and territories. The virus is primarily spread through the bite of an infected Aedes species mosquito. Other modes of transmission include mother-to-child transmission, blood transfusion and sexual transmission.

Currently there are a few diagnostic tests that can determine the presence of the virus that are available through the CDC and CDC-approved state health laboratories.

Highlight The Rationale for Zika Testing

Medicare Part B pays for clinical diagnostic laboratory tests that are reasonable and necessary for the diagnosis or treatment of a person’s illness or injury. Presently there are no specific HCPCS codes for testing of the Zika virus; however, laboratories should contact their local MACs for guidance on the appropriate billing codes to use on claims for Zika virus testing. Laboratories should also provide resources and cost information that will allow the MACs to establish appropriate payment amounts for the tests.

Take Home Point: 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.

Code the Symptoms — or Lack Thereof — That Make You Suspect Zika Virus

Since it is the diagnostic lab test that confirms the Zika diagnosis, patients with Zika viral illnesses may present with symptoms other than fever such as: maculopapular rash, arthralgia, conjunctivitis, headache and myalgia. Report the symptoms when the disease is not confirmed, Todt explains. Such diagnoses include:

• R50.9 — Fever, unspecified
• R21 — Rash and other nonspecific skin eruption
• M79.1 — Myalgia
• M25.5 — Pain in joint (use code for specific joint when appropriate)
• R51 — Headache

Use one of these codes instead of the Zika diagnosis code if the patient has symptoms, but Zika infection is not confirmed. 

Asymptomatic: When you’re reporting a Zika virus screening for asymptomatic patients, you have a couple of code choices. If the patient has no symptoms but meets the epidemiological testing criteria based on travel to a transmission zone, you can report Z11.59 (Encounter for screening for other viral diseases).

When testing an asymptomatic patient who had sexual contact with a person who traveled to a transmission zone and/or shows Zika symptoms, you should report Z20.828 (Contact with and [suspected] exposure to other viral communicable diseases). If the patient has symptoms, you would instead report Z11.3 (Encounter for screening for infections with a predominantly sexual mode of transmission), along with symptom codes.

Special Note: The ICD-10 rule for use of Z20 codes is: “Category Z20 indicates contact with, and suspected exposure to, communicable diseases. These codes are for patients who do not show any sign or symptom of a disease but are suspected to have been exposed to it by close personal contact with an infected individual or are in an area where a disease is epidemic.”

Your Current A92.8 Option Will Change

However, suppose the lab confirms the Zika virus. Right now, the best you can do to report a case of confirmed Zika infection is to list A92.8 (Other specified mosquito-borne viral fevers).

But the ICD-10-CM Coordination and Maintenance Committee recently considered a new, more specific code: A92.5 (Zika virus disease). Although the code didn’t make it to the proposed code list for ICD-10 2017, the committee is expecting the code to make it to ICD-10 2017 addenda.

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