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Diagnosis Code Reporting for Screening for STIs and HIBC to Prevent STIs (Rev. 2476, 02-27-12)

By:  Jared Staheli
Published:  July 6th, 2015

A claim that is submitted for screening chlamydia, gonorrhea, syphilis, and/or hepatitis B shall be submitted with one or more of the following diagnosis codes in the header and pointed to the line item:

a. For claims for screening for chlamydia, gonorrhea, and syphilis in women at increased risk who are not pregnant use the following diagnosis codes:

V74.5 – Screening, bacterial – sexually transmitted; and

V69.8 - Other problems related to lifestyle as secondary (This diagnosis code is used to indicate high/increased risk for STIs).

b. For claims for screening for syphilis in men at increased risk use the following diagnosis codes:

V74.5 – Screening, bacterial – sexually transmitted; and

V69.8 - Other problems related to lifestyle as secondary.

c. For claims for screening for chlamydia and gonorrhea in pregnant women at increased risk for STIs use the following diagnosis codes:

V74.5 – Screening, bacterial – sexually transmitted; and

V69.8 - Other problems related to lifestyle, and,

V22.0 – Supervision of normal first pregnancy, or

V22.1 – Supervision of other normal pregnancy, or,

V23.9 – Supervision of unspecified high-risk pregnancy.

d. For claims for screening for syphilis in pregnant women use the following diagnosis codes:

V74.5 – Screening, bacterial – sexually transmitted; and

V22.0 – Supervision of normal first pregnancy, or,

V22.1 – Supervision of other normal pregnancy, or,

V23.9 – Supervision of unspecified high-risk pregnancy.

e. For claims for screening for syphilis in pregnant women at increased risk for STIs use the following diagnosis codes:

V74.5 – Screening, bacterial – sexually transmitted; and

V69.8 - Other problems related to lifestyle, and,

V22.0 – Supervision of normal first pregnancy, or

V22.1 – Supervision of other normal pregnancy, or,

V23.9 – Supervision of unspecified high-risk pregnancy.

f. For claims for screening for hepatitis B in pregnant women use the following diagnosis codes:

V73.89– Screening, disease or disorder, viral, specified type NEC; and

V22.0 – Supervision of normal first pregnancy, or,

V22.1 – Supervision of other normal pregnancy, or,

V23.9 – Supervision of unspecified high-risk pregnancy.

g. For claims for screening for hepatitis B in pregnant women at increased risk for STIs use the following diagnosis codes:

V73.89– Screening, disease or disorder, viral, specified type NEC; and

• V 69.8 - Other problems related to lifestyle, and,

V22.0 – Supervision of normal first pregnancy, or,

V22.1 – Supervision of other normal pregnancy, or,

V23.9 – Supervision of unspecified high-risk pregnancy.

ICD-10 Diagnosis Coding:

Contractors shall note the appropriate ICD-10 code(s) that are listed below for future implementation. Contractors shall track the ICD-10 codes and ensure that the updated edit is turned on as part of the ICD-10 implementation effective October 1, 2013.

ICD-10 Description
Z11.3 Encounter for screening for infections with a predominantly sexual mode of transmission
Z11.59 Encounter for screening for other viral diseases
Z72.89 Other problems related to lifestyle
Z34.00 Encounter for supervision of normal first pregnancy, unspecified trimester
Z34.80 Encounter for supervision of other normal pregnancy, unspecified trimester
O09.90 Supervision of high risk pregnancy, unspecified, unspecified trimester

 


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