decisionhealth Newsletters, Coder Pink Sheets - 2006 Issue 1 (January)
HIV testing: Underlying reason for test could determine payment
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Article Overview
This article discusses payment issues for HIV testing under Part B and private payer policies, with emphasis on how the patient’s condition, history, and stated reason for testing can affect coverage. It covers general categories of HIV screening, symptomatic testing, counseling, diagnosis coding, and payer policy examples relevant to OB-GYN and similar clinical settings.
Why This Topic Matters
Understanding how HIV testing is evaluated for payment helps providers document the reason for testing more completely and select the appropriate supporting diagnosis categories. It is especially relevant to practices that perform screening, counseling, or evaluation for possible HIV infection.
What You Will Learn
- How payment for HIV testing may depend on the reason the test is ordered
- The difference between screening-related testing and testing prompted by symptoms
- How counseling related to HIV testing may be reported at a high level
- Why patient history can affect whether testing is paid by a payer
- How payer policy examples may influence coverage for routine HIV testing
Who Should Read This
- Medical coders
- Billing staff
- OB-GYN practices
- Clinicians documenting HIV testing
- Revenue cycle staff
Codes Discussed
Code Ranges Discussed
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