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suzyrene

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My office currently codes for services provided outside of California. We are going to be coding for services in California in the near future. I am trying to find out what California law states when it comes to a patient with HIV positive status. I have heard the topic brought up at seminars that the V08 code can not be billed in California. I am trying to locate the documentation on the California law. I would be grateful to anyone that can help.
 
There is no law that states you cannot use certain codes. If the patient is asymptomatic HIV+ status the appropriate code is V08 and it is allowed first or secondary. It may be used secondary if the HIV status is a factor in the complexity of the encounter. The dx belongs to the patient and the state is not allowed to dictate to us the appropriate codes to use for a patient dx as dictated by the provider.
 
California specific law

Thank you for your response. I have been to a couple of seminars where the California codes HIV and Aids differently then the rest of the country has been brought up. This would be a law specific to California. Every other state ad hears to the coding guidelines, but it has been stated that California has a law that needs to be followed.
 
Sorry I have billed a lot in California and there is no such law, and they cannot have their own guidelines for coding HIV and AIDS. The codes are as they are and the guidelines are HIPAA mandated to be adhered to.
You are referring to the law governing the reporting of lab results. You are not allowed to use either the V08 or the 795.71 code for lab results. This is due to the numerous instances of false positive results. You must wait for the providers definitive diagnosis of HIV+ status.
 
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Just want to make sure

Debra,
I just want to make sure that I am understanding. The Law only applies to the lab results, Correct? If I have a provider that has completed an in home evaluation and has documented HIV positive I can use the code V08 as per the coding guidelines. Am I correct?
 
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The only law on the books is in reference to the reporting of lab results. If the patient is diagnoses as HIV+ per the provider and there is no history of an HIV related illness past or present then yes V08 may be reported.
 
CA laws on reporting HIV status

I know this is an old thread, but for future readers concerned about reporting certain HIV codes in California, please refer to the following link.

Warning Flag on HIV Test Result If ICD-9-CM codes for the HIV test results are reported in your data, they will be flagged with a warning edit flag. Diagnosis code V08 or 795.71 reported in the principal diagnosis or other diagnosis field will be flagged with a SW05 or SW06 warning flag. Why does OSHPD edit these codes? This warning edit was designed to protect health facilities from further liability if the coder forgot or didn't know about the California Health and Safety Code section that prohibits the disclosure of any results of an HIV test whether positive, negative, or inconclusive without patient?s written authorization for each disclosure. The only exception to the Health and Safety Code, is that the HIV test result must be reported to the public health agency. Most health facilities are not always aware of the differences between a public health agency and OSHPD when reporting the HIV test results. OSHPD is NOT a public health agency. OSHPD is not held liable for the reported codes. Health facilities, however, could ultimately be held responsible for disclosing that information without the patient's signed consent.

http://www.oshpd.ca.gov/HID/MIRCal/Text_pdfs/Bulletins/QuickNotesV10_extended.pdf
 
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