STI Screening vs Diagnostic

efarley

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Eugene, OR
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I have been providing guidance to my clinicians that if patient presents with a complaint such as vaginitis or penile discharge and they order labs to test for STIs, then they should only report the symptoms and not the Z11 code(s). However, when I review some of the payers' policies regarding coverage of these tests, the common symptoms are not listed as covered diagnoses.

Per ICD-10-CM official guidelines (Ch 21.c.5), "The testing of a person to rule out or confirm a suspected diagnosis because the patient has some sign or symptom is a diagnostic examination, not a screening. In these cases, the sign or symptom is used to explain the reason for the test."

Am I misinterpreting this?
 
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If the reason for the encounter is a "problem" and the provider orders tests, then it's diagnostic. You'd code the visit with the problem/complaint/symptoms DX as primary and no DX code for the testing. The ordering of the tests just gets counted when leveling the visit as additional workup. If the patient presented with no complaints then it'd be a screening, eg, annual pap.
 
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