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Dx for HIV screening

  1. #1
    St. Louis
    Default Dx for HIV screening
    Medical Coding Books
    Pt came in to UC with concern of STD/HIV. Ordered HIV screening and it was denied using the V69.2 High Risk Sexual Behavior. Does anyone know where I can find a list of covered dx. I looked on CMS and cannot find it.


  2. #2
    St. Louis
    I found the list. I went with V01.79. Thanks

  3. Default
    Unless you have documentation to support that the patient has had exposure or contact with an individual with either HIV or STD's you can not use that code, especially with a government insurance such as medicare or medicaid. It is considered fraud - you can not bill a code because it is on the list. Also, unless you have proof that the patient exhibits high risk sexual behaviors you shouldn't use that code either. V69.2 is a dx that is typically given when a patient exhibits promiscuity. STD screenings (which include HIV) is coded with V74.5 and if that isn't covered than you will have to get a better dx from the ordering Doc.

  4. #4
    St. Louis
    There was supporting documentation of contact with a known infected indvidual and documentation that patient admits to high risk sexual behaviors. I only wanted the covered diagnosis list for reference to give the doc.
    Thanks for the V74.5 code, I will show that to my doc also.

  5. #5
    Columbia, MO
    HIV screening.g is not code as screening for STD looking in your coding guidelines. It is coded as screening for other specified viral disease. HIV is not an STD it is a viral disease.

    Debra A. Mitchell, MSPH, CPC-H

  6. Default HIV Guidelines
    I know this is an old post, but I wanted to comment because we were having issues getting reimbursement with the V74.5 diagnosis code and I want to make sure others have a reference:

    HIV Screening guidelines:

    If a patient is being seen to determine his/her HIV status, use code V73.89, Screening for other specified viral disease. Use code V69.8, Other problems related to lifestyle, as a secondary code if an asymptomatic patient is in a known high risk group for HIV. Should a patient with signs or symptoms or illness, or a confirmed HIV related diagnosis be tested for HIV, code the signs and symptoms or the diagnosis. An additional counseling code V65.44 may be used if counseling is provided during the encounter for the test.

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