Wiki coding help with Z11.3 & cpt 86592, 87491, 87591

[doc67us]

If I can get any help for this coding issue, I am getting this message in our clearing house. I am not sure if we need to add an additional diagnosis code. We have tried Z20.2 but this is not working to clear the error for send a clean bill. Billing is laboratory for OH claims. Any suggestions would be helpful.

For procedure 86592 diagnosis I10,R63.5,E55.9,Z11.3 requires additional diagnosis code. Review policy. POL: Screening for Sexually Transmitted Infections (STIs) and High-Intensity Behavioral Counseling (HIBC) to Prevent STIs URL: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1388OTN.pdf

 

[mitchellde]

Within that reference is a reference to NCD 210.10 .. in that NCD for coverage for testing for STD code Z11.3 will be covered if submitted with Z72.89 Problems related to lifestyle.. defined in the NCD as:
• Women at increased risk for STIs annually.
The high/increased risk individual sexual behaviors, based on the USPSTF guidelines, include any of the following:
• Multiple sex partners
• Using barrier protection inconsistently
• Having sex under the influence of alcohol or drugs
• Having sex in exchange for money or drugs
• Age (24 years of age or younger and sexually active for women for chlamydia and gonorrhea)
• Having an STI within the past year
• IV drug use (hepatitis B only)
• In addition for men – men having sex with men (MSM) and engaged in high risk sexual behavior, but no regard to
age
Note: 11 full months must elapse following the month in which the previous test was performed in order for the
subsequent test to be covered.
If this is not documented then you would not be able to add the necessary for the coverage and the test will be denied.

 

[doc67us]

Thank You mitchellde, I am still new to coding. You helped me understand the links to CMS.