Coding for STI Screening in Pregnancy

Screening for sexually transmitted infections (STI) is a critical component to preventing the spread of STIs. The Centers for Disease Control and Prevention (CDC) estimates that STIs acquired in 2018 cost the American healthcare system nearly $16 billion in direct medical costs. It was also estimated that nearly one in five people in the U.S. had an STI on any given day in 2018. The CDC has detailed recommendations for STI screenings, including syphilis, gonorrhea, and chlamydia. For accurate ordering and medical documentation for STI screening in pregnancy, please see the coding guidance below.

Encounter Codes (ICD-10-CM) for Ordering Tests

• Z11.3 – Encounter for screening for infections with a predominantly sexual mode of transmission
• Z11.59 – Encounter for screening for other infectious and parasitic diseases
• Z22.8 – Carrier of other infectious disease
• Z33.1 – Pregnant state, incidental
• Z34.00 – Encounter for supervision of normal first pregnancy, unspecified trimester
• Z34.01 – Encounter for supervision of normal first pregnancy, first trimester
• Z34.02 – Encounter for supervision of normal first pregnancy, second trimester
• Z34.03 – Encounter for supervision of normal first pregnancy, third trimester
• Z34.80 – Encounter for supervision of other normal pregnancy, unspecified trimester
• Z34.81 – Encounter for supervision of other normal pregnancy, first trimester
• Z34.82 – Encounter for supervision of other normal pregnancy, second trimester
• Z34.83 – Encounter for supervision of other normal pregnancy, third trimester
• Z34.90 – Encounter for supervision of normal pregnancy, unspecified, unspecified trimester
• Z34.91 – Encounter for supervision of normal pregnancy, unspecified, first trimester
• Z34.92 – Encounter for supervision of normal pregnancy, unspecified, second trimester
• Z34.93 – Encounter for supervision of normal pregnancy, unspecified, third trimester
• Z72.51 – High risk heterosexual behavior
• Z72.52 – High risk homosexual behavior
• Z72.53 – High risk bisexual behavior
• Z72.89 – Other problems related to lifestyle (to be used with HCPCS code G0472)
• Z86.19 – Personal history of other infectious and parasitic diseases
• O09.90 – Supervision of high risk pregnancy, unspecified, unspecified trimester
• O09.91 – Supervision of high risk pregnancy, unspecified, first trimester
• O09.92 – Supervision of high risk pregnancy, unspecified, second trimester
• O09.93 – Supervision of high risk pregnancy, unspecified, third trimester

Procedural Codes (CPT) for Ordering or Billing for STI Screening in Pregnancy

Disease Codes with Long Descriptor

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Chlamydia

• 86631 – Antibody; Chlamydia

• 86632 – Antibody; Chlamydia, IgM

• 87110 – Culture, chlamydia, any source

• 87270 – Infectious agent antigen detection by immunofluorescent technique; Chlamydia trachomatis

• 87320 – Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; Chlamydia trachomatis

• 87490 – Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, direct probe technique

• 87491 – Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique

• 87800 – Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique*

• 87810 – Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Chlamydia trachomatis *Use for combined chlamydia and gonorrhea testing

*Use for combined chlamydia and gonorrhea testing

Gonorrhea

• 87590 – Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, direct probe technique

• 87591 – Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique

• 87850 – Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Neisseria gonorrhoeae

• 87800 – Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique*

*Use for combined chlamydia and gonorrhea testing

Hepatitis B

• 86704 – Hepatitis B core antibody (HBcAb); total

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  86706 – Hepatitis B surface antibody (HBsAb)

• 87340 – Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; hepatitis B surface antigen (HBsAg)

• 87341 – Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; hepatitis B surface antigen (HBsAg) neutralization

Hepatitis C

• 86803 – Hepatitis C antibody

• 86804 – Hepatitis C antibody; confirmatory test (e.g., immunoblot)

• 87520 – Infectious agent detection by nucleic acid (DNA or RNA); hepatitis c, direct probe technique

• 87521 – Infectious agent detection by nucleic acid (DNA or RNA); hepatitis c, amplified probe technique, includes reverse transcription when performed

• 87522 – Infectious agent detection by nucleic acid (DNA or RNA); hepatitis c, quantification, includes reverse transcription when performed

• 87902 – Infectious agent genotype by nucleic acid (DNA or RNA); Hepatitis c virus

• G0472 – Hepatitis C antibody screening at high risk and other covered indication(s)**

**Medicare-covered code

HIV

• 86689 – Antibody; HTLV or HIV antibody, confirmatory test (eg, Western Blot)

• 86701 – Antibody; HIV-1

• 86702 – Antibody; HIV-2

• 87534 – Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, direct probe technique

• 87535 – Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, amplified probe technique, includes reverse transcription when performed

• 87536 – Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, quantification, includes reverse transcription when performed

• 87390 – Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; HIV-1

Syphilis

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  86592 – Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART)

• 86593 – Syphilis test, non-treponemal antibody; quantitative

• 86780 – Antibody; Treponema pallidum

Evaluation and Management (E/M) Level for Coding and Billing for STI Screening – Office/Preventive Visits

CPT Codes (Minutes must be met or exceeded) Description

• 99202 (15)

• 99203 (30)

• 99204 (45)

• 99205 (60)

Office or other outpatient visit for the E/M of a new patient which requires a medically appropriate history and/or examination.

• 99211

• 99212 (10)

• 99213 (20)

• 99214 (30)

• 99215 (40)

Office or other outpatient visit for the E/M of an established patient which requires a medically appropriate history and/or examination.

• 99401 (15)

• 99402 (30)

• 99403 (45)

• 99404 (60)

Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure)

Always check with your laboratory to determine the appropriate code and process for ordering an STI test in a pregnant patient. Some laboratories may have a bundled code that includes all of the initial tests typically performed for pregnancy.

Additionally, it is critical to confirm with the payer to determine coverage parameters for certain STI tests in pregnancy by each individual payer. If a payer is not covering a recommended test, please let us know through our Payment Advocacy and Policy Portal.

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