National Clinical Training Center for Family Planning



Official Podcast TranscriptTitle: Coding with Ann Episode 13: PEPSpeaker: Ann FinnDuration: 00:09:15NCTCFP (00:00):Hello, and welcome to the Family Planning Files, a podcast from the National Clinical Training Center for Family Planning. The National Clinical Training Center for Family Planning is one of the training centers funded through the Office of Population Affairs to provide programming to enhance the knowledge of family planning staff. I'm your host, Katherine Atcheson.NCTCFP (00:23):Our guest speaker today is Ann Finn, from our popular Coding with Ann series. Ann heads Anne Finn Consulting, LLC, where she's a healthcare reimbursement and billing and coding consultant. Ann has worked as a national trainer with many reproductive healthcare organizations since establishing Ann Finn Consulting in 2003.NCTCFP (00:42):Today we're going to be talking about coding for post-exposure prophylaxis or PEP, for our 13th episode of Coding with Ann. This podcast is met as an accompaniment to the NCTCFP's Virtual Coffee Break Webinarette on billing and coding for PrEP or pre-exposure prophylaxis, done with Edwin Corbin-Gutierrez from NASTAD. If you haven't had a chance to watch that Virtual Coffee Break, it is available on NCTCFP's website . And now, welcome back to the podcast Ann.Ann Finn (01:16):Thank you so much, Katherine. To recap a few important points that were made during our PrEP session, pertaining to family planning providers, family planning clinics have a critical role to play in PrEP and PEP scale up. Family planning clinics are particularly well equipped to provide affirming, inclusive sexual health services. From an author report facing judgment from their primary provider and unwillingness to discuss sexual behaviors and practices, emphasizing the importance of ensuring that PrEP and PEP are available to family planning clinics.Ann Finn (01:48):Family planning clinics have also demonstrated excellence in managing vulnerable patient populations, helping patients navigate through complex healthcare coverage barriers, to ensure that cost is not the barrier to access care and providing low barrier delivery models of care. We learned that PrEP relates to people at risk who take daily medicine to prevent HIV. PrEP can stop HIV from taking hold and spreading throughout your body. When taken daily, PrEP is highly effective for preventing HIV from sex or injection drug use.Ann Finn (02:21):So what is PEP? PEP stands for post-exposure prophylaxis and is a provision of medications to prevent transmission of a disease or illness following an occupational and non-occupational exposure. It includes a series of pills taken over 28 days to prevent someone from contracting HIV after possible exposure. It is intended for emergency use only and is not a sustainable method of HIV prevention. PEP is covered by most private insurance plans and Medicaid, but there are resources available if the patient is uninsured. Once a person has completed their 28 day treatment, they should discuss PrEP with their provider.Ann Finn (03:00):There are two types of PEP. Non occupational PEP or nPEP, is taken when an individual is potentially exposed to HIV outside the workplace. For example, during episodes of unprotected sex or needle sharing injection drug use. Occupational PEP or oPEP is taken when an individual working in a healthcare setting is potentially exposed to products or materials that could be, or are known to be infected with HIV. There may be additional ICD diagnosis codes used to describe the exposure, such as the series W46.0 contact with hypodermic needle.Ann Finn (03:37):It's important to remember frequent changes and standards of HIV prevention and care require that the guidelines be carefully reviewed by your medical team in your facility to assure they conform to acceptable local and current approaches. It's wise to consult with your payers to ensure these services are accurately coded and reimbursed so you don't lose out on revenue. Patients presenting for PEP should be evaluated as soon as possible so treatment, if indicated, can be initiated within recommended timeframes. To be most effective, evidence currently suggests a 72-hour timeframe for the initiation of PEP, following possible HIV exposure. Remember PEP treatment should be initiated as soon as possible, following the exposure.Ann Finn (04:19):A few sexual, HIV, acquiring risks include, a patient having unprotected intercourse, such as with no condom or PrEP or vaginal assault with a known person living with HIV, which uses the acronym PLWH or someone of unknown HIV status. It also includes unprotected rectal intercourse or assault with a known person living with HIV or someone of unknown status. Common baseline tests to consider for persons being seen for PEP include, gonorrhea and chlamydia, includes swabs of all sites of sexual contact. Urine testing may also be considered in place of genital testing. Rapid HIV antigens and antibody testing, urine pregnancy tests for persons of risk of pregnancy, routine blood work and assessing renal and liver function, syphilis serology or RPR and hepatitis B virus surface antigen for those with known or probable prior HPV infections.Ann Finn (05:16):While there are not specific ICD-10 codes for PrEP and PEP related services, the following diagnosis codes could be used to support the lab testing ordered above and HIV counseling. Z20.6, contact with and suspected exposure to HIV. Z20.2 is contact with, and expected exposure to, infections with a predominantly sexual mode of transmissions such as STDs. Z20.5 is contact with, and suspected exposure to, viral hepatitis. Z77.21 is contact with, and suspected exposure to, potentially hazardous body fluids. Z32.02 is pregnancy testing with a negative result and Z71.7, HIV counseling.Ann Finn (06:06):Remember, use screening and/or contact with codes for PEP, since the patient has not been diagnosed with HIV at this point. Include codes of support known risk factors, such as W46.0 contact with hypodermic needle or Z72.51 high risk heterosexual behavior, Z72.52 high risk homosexual behavior, or Z72.53 high risk bisexual behavior. If the patient is also counseled on family planning or prescribed birth control during the same visit, we'd also wants to include the appropriate diagnosis code Z30 contraceptive management services such as Z30.09 family planning counseling, Z30.013 initiation of injectable contraception or Depo-Provera, or Z32.012 emergency contraception, if EC is prescribed or dispensed.Ann Finn (07:02):To code for patients that have been confirmed as positive with HIV, it is best to refer to your official ICD-10 guideline requirements outlined in chapter one, a certain infectious and parasitic diseases, in the code range, A00 through B99, including B20 HIV disease or Z21 asymptomatic HIV infection status. If you are new to providing PEP and PrEP services, there are many tools and resources available to help you. And of course, we always recommend talking to your payers to review specific requirements, including evaluation and management medical visit codes, accepted counseling codes, such as 99401 or 99405 and expected reimbursements, including the counseling and tested provided. We appreciate your listening to our podcasts and thank you for joining us todayNCTCFP (07:53):And thank you for joining us today Anne, and sharing your time and expertise. For more content, search for the Family Planning Files or subscribe to our show on iTunes, Apple podcasts, Google podcasts, Spotify, Stitcher, or wherever you listen to podcasts. For a transcript of this podcast, as well as other online learning activities and continuing education opportunities, please visit our website at .NCTCFP (08:20):This podcast is supported by award number 5FPTPA006029-02-00 from the U.S. Department of Health and Human Services, Office of the Assistant Secretary of Health or OASH, Office of Population Affairs or OPA. Its contents are solely the responsibility of the presenters and do not necessarily represent the official views of HHS, OASH or OPA. Theme music written by Dan Jones and performed by Dan Jones and The Squids. Other production support provided by the Collaborative to Advance Health Services at the University of Missouri, Kansas City, School of Nursing and Health Studies. And thank you to our listeners for tuning in today. We hope that you'll join us next time for another episode of The Family Planning Files. ................
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