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ICD-10 Guide
ICD-10 CodesZ29.81

Z29.81

Encounter for HIV pre-exposure prophylaxis

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/12/2025

Code Description

ICD-10 Z29.81 is a billable code used to indicate a diagnosis of encounter for hiv pre-exposure prophylaxis.

Key Diagnostic Point:

Z29.81 is used to document encounters for HIV pre-exposure prophylaxis (PrEP), a preventive strategy for individuals at high risk of HIV infection. This code reflects the importance of preventive care in managing health risks associated with HIV. Factors influencing health status include socioeconomic status, access to healthcare, and education about HIV transmission and prevention. Social determinants such as housing stability, employment, and community support systems play a crucial role in an individual's ability to engage in preventive health measures. Regular encounters for PrEP not only provide medication but also involve counseling, risk assessment, and routine screenings for HIV and other sexually transmitted infections (STIs). This proactive approach is essential in reducing the incidence of HIV and improving overall public health outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for thorough documentation of risk factors for HIV
  • Requirement for regular follow-up visits and lab tests
  • Potential for co-morbid conditions that may complicate coding
  • Variability in payer requirements for PrEP coverage

Audit Risk Factors

  • Inadequate documentation of patient risk factors
  • Failure to document counseling and education provided
  • Missing follow-up visit records
  • Incorrect sequencing of codes related to HIV testing

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Document patient history, risk factors, and counseling provided during encounters.

Common Clinical Scenarios

Routine checkups for patients on PrEP, follow-up visits for medication refills, and screenings for STIs.

Billing Considerations

Consider social determinants such as access to transportation and housing stability when assessing patient adherence to PrEP.

Public Health

Documentation Requirements

Document population-level data, surveillance of HIV incidence, and outreach efforts.

Common Clinical Scenarios

Community health initiatives promoting PrEP, epidemiological studies assessing PrEP effectiveness.

Billing Considerations

Focus on health equity and access to PrEP among marginalized populations.

Coding Guidelines

Inclusion Criteria

Use Z29.81 When
  • Z codes are used to indicate encounters for preventive care and should be sequenced appropriately with any related diagnosis codes
  • Payer requirements may vary, so it is essential to verify coverage for PrEP and associated services
  • Documentation must support the medical necessity of the encounter

Exclusion Criteria

Do NOT use Z29.81 When
No specific exclusions found.

Related CPT Codes

99401CPT Code

Preventive medicine counseling and risk factor reduction intervention

Clinical Scenario

Used during PrEP encounters to document counseling provided.

Documentation Requirements

Document the time spent and topics covered during counseling.

Specialty Considerations

Important for primary care providers to ensure comprehensive preventive care.

80061CPT Code

Lipid panel

Clinical Scenario

Often performed during PrEP follow-up visits to monitor overall health.

Documentation Requirements

Include results and any necessary follow-up actions.

Specialty Considerations

Relevant for assessing cardiovascular risk in patients on PrEP.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding encounters for preventive care, including PrEP. This specificity aids in better tracking of health outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding encounters for preventive care, including PrEP. This specificity aids in better tracking of health outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding encounters for preventive care, including PrEP. This specificity aids in better tracking of health outcomes and resource allocation.

Resources

Clinical References

  • •
    CDC PrEP Guidelines
  • •
    AIDSinfo: PrEP Information

Coding & Billing References

  • •
    CDC PrEP Guidelines
  • •
    AIDSinfo: PrEP Information

Frequently Asked Questions

What documentation is required for Z29.81?

Documentation must include patient risk factors for HIV, counseling provided, and any follow-up plans. It is essential to capture the comprehensive nature of the preventive care provided during the encounter.