SPRING 2013

 

Come Take a Look!

Member Satisfaction

Utilization Review Criteria Update

Medical Director Availability After an Adverse Determination

EmblemHealth Neighborhood Care Success Stories

EmblemHealth Introduces National Diabetes Prevention Program

Appointment Availability and Access Surveys

Claims Corner

Submit Claims with Accurate Pay To Information

CareCore Manages Accreditation and Privileging for SRPP

Changes to Look Back Period for Medicare

Behind the Scenes

Help Your Patients Understand

Member Rights and Responsibilities

Correctly Coding HIV Care

Healthy Beginnings PATH Updates

Healthy Discounts for Members

EmblemHealth Resources for Managing Your Patients With HIV/AIDS

Brochure for Teens Now Available!

Low Dose Aspirin Therapy

Managing and Treating LDL Levels

Dental Hygiene Is Important

Clinical Corner

News&Notes Archive

  

Correctly Coding HIV Care

Your patients living with HIV/AIDS need ongoing primary care for their HIV and additional preventive health care requirements. At minimum, members living with HIV/AIDS should have two primary care visits (family practice, internal medicine, pediatric, OB/GYN or infectious disease practitioners) per year to monitor their condition, with one outpatient visit occurring every six months. Go to our HIV/AIDS Case Management Web page for more information.

A table for proper coding of these visits is provided below. Please use these codes when submitting claims for the care of your EmblemHealth members with HIV/AIDS.

OUTPATIENT VISIT CODING
 Description CPT UB Revenue ICD-9-CM Diagnosis
Outpatient Visit 99201-99205, 99211-99215, 99341-99345, 99347-99350, 99354-99355, 99382-99387, 99392-99397, 99401-99404, 99411, 99412,99420, 99429, 99455, 99456 051x,
0520-0523,
0526-0529, 082x-085, 088x, 0982, 0983
V08, 042, V20.2, V70.0, V70.3, V70.5, V70.6, V70.8, V70.9

 

Patients with HIV/AIDS also require two viral load monitoring tests, with one test performed during each half of the year; they must also have one syphilis screening per year.

VIRAL LOAD MONITORING CODING
 Description CPT LOINC
Viral Load Test 987534-87536,
87537-87539
10351-5, 20447-9, 21008-8, 21333-0, 23876-6, 25836-8, 29539-4, 29541-0, 41513-3, 41514-1, 41515-8, 41516-6, 48510-2, 48511-0, 48551-6, 48552-4, 49890-7, 51780-5, 59419-2, 62469-2, 70241-5
SYPHILIS SCREENING CODING
 Description CPT LOINC
Viral Load Test 86592, 86593
86780
11084-1, 11597-2, 13288-6, 17723-8, 17724-6, 17725-3, 17726-1, 17727-9, 17728-7, 17729-5, 20507-0, 20508-8, 22461-8, 22462-6, 22585-4, 22587-0, 22590-4, 22592-0, 22594-6, 24110-9, 24312-1, 26009-1, 29310-0, 31147-2, 34147-9, 34382-2, 34954-8, 40679-3, 40680-1, 47236-5, 47237-3, 47238-1, 50690-7, 51838-1, 51839-9, 5291-0, 5292-8, 53605-2, 5392-6, 5393-4, 5394-2, 57032-5, 63464-2, 6561-5, 6562-3, 68502-4, 71793-4, 8041-6
   
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