tci Outpatient Facility Coding Alert - 2016 Issue 8

Reader Question: Ensure Accuracy in HIV Screening Reporting

Question: What are the points to keep in mind while reportingscreening a Medicare-covered patient for HIV infection? Texas Subscriber Answer: Here, you will need toreport appropriate diagnosis codes to help support the necessity of screening and to allow coverage to obtain reimbursement for the screening. Considering the patient’s age, you have two options: Age between 15 to 65: Without regard to the risk of HIV, your claim for G0475 (HIV antigen/antibody, combination assay, screening) should be reported with the primary diagnosis code as Z11.4 (Encounter for screening for human immunodeficiency virus [HIV]). Aged below 15 or older...

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