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 |
|---|---|
|
Chlamydia |
*Use for combined chlamydia and gonorrhea testing |
|
Gonorrhea |
*Use for combined chlamydia and gonorrhea testing |
|
|
**Medicare-covered code |
|
|
|
|
Syphilis |
|
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 |
|---|---|
|
Office or other outpatient visit for the E/M of a new patient which requires a medically appropriate history and/or examination. |
|
Office or other outpatient visit for the E/M of an established patient which requires a medically appropriate history and/or examination. |
|
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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