Pain Management Coding Alert

Published on Thu Nov 03, 2016 PDF

Question: We don’t typically get patients with Zika virus, but the physician recently treated a pregnant patient with a confirmed diagnosis of Zika for headaches. Notes indicate a level-three office E/M service. Have there been any changes in how you should report an ICD-10 code for the Zika virus?

Washington, DC Subscriber

Answer: As of October 1, there is a new ICD-10 code on the books for Zika: A92.5 (Zika virus disease).

Remember: You’ll use this code for all E/M services the physician provides after October 1, when ICD-10 2017 takes effect. So if the date of service for your claim is on or after October 1, you should report 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history;

an expanded problem focused examination; medical decision making of low complexity…) for the E/M with A92.5 appended.

If you are coding for services dated before Oct. 1, 2016, however, you should not report A92.5. Before the new code came along, coders reported most instances of Zika with A92.8 (Other specified mosquito-borne viral fevers).

Check it out: To see a complete list of the 2017 ICD-10 code additions, deletions, and revisions, see www.cdc.gov/nchs/icd/icd10cm.htm.