Automated World Health

L29416

 

SYPHILIS TEST

 

01/01/2010

 

Indications and Limitations of Coverage and/or Medical Necessity

• Medicare does not pay for routine screening tests. ICD-9-CM code V82.9, (special screening of other conditions, unspecified condition), or comparable narratives should be used to indicate screening tests performed in the absence of a specific sign, symptom, or complaint.

o Inappropriate use of V82.9 or lack of comparable narrative will result in the denial of claims as non-covered screening services.

• Reviewing results of laboratory tests, phoning results to patients, filing such results, and such activities as obtaining, reviewing, and analyzing the appropriate diagnostic tests, etc., are services which are covered by the program, and payment for these services is included in the payment for the evaluation and management (E&M) services of the patient.

• Medicare covered qualitative syphilis testing (CPT 86592) is indicated only when there are clinical findings of the

o skin

o eyes

o teeth

o cardiovascular system

o Central nervous system that suggest syphilitic infection.

• Quantitative syphilis testing (CPT 86593) is indicated only when

o there has been previous positive result of either 86592 or 86780 but is

o Never indicated when 86592 is negative.

• Confirmatory and specific treponemal testing is indicated only when

o there has been a previous positive test result of qualitative syphilis testing (86592) and

o very rarely when clinical disease particularly in the central nervous system (CNS) suggests tertiary syphilitic disease of

 meningoencephalitis,

 tabes dorsalis, or

 General paresis, despite a negative qualitative test for syphilis (86592).

• Quantitative syphilis testing (CPT 86593) is indicated in the follow up of previous positive testing at periodic intervals not to exceed semiannually until seronegativity occurs.

 

 

CPT/HCPCS Codes

 

86592 SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (EG, VDRL, RPR, ART)

86593 SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUANTITATIVE

86780 ANTIBODY; TREPONEMA PALLIDUM

 

 

ICD-9 Codes that Support Medical Necessity

 

042 HUMAN IMMUNODEFICIENCY VIRUS (HIV) DISEASE

053.0 HERPES ZOSTER WITH MENINGITIS

053.10 HERPES ZOSTER WITH UNSPECIFIED NERVOUS SYSTEM COMPLICATION

053.11 GENICULATE HERPES ZOSTER

053.12 POSTHERPETIC TRIGEMINAL NEURALGIA

053.13 POSTHERPETIC POLYNEUROPATHY

053.14 HERPES ZOSTER MYELITIS

053.19 HERPES ZOSTER WITH OTHER NERVOUS SYSTEM COMPLICATIONS

053.20 HERPES ZOSTER DERMATITIS OF EYELID

053.21 HERPES ZOSTER KERATOCONJUNCTIVITIS

053.22 HERPES ZOSTER IRIDOCYCLITIS

053.29 HERPES ZOSTER WITH OTHER OPHTHALMIC COMPLICATIONS

053.71 OTITIS EXTERNA DUE TO HERPES ZOSTER

053.79 HERPES ZOSTER WITH OTHER SPECIFIED COMPLICATIONS

053.8 HERPES ZOSTER WITH UNSPECIFIED COMPLICATION

053.9 HERPES ZOSTER WITHOUT COMPLICATION

054.0 ECZEMA HERPETICUM

054.10 GENITAL HERPES UNSPECIFIED

054.11 HERPETIC VULVOVAGINITIS

054.12 HERPETIC ULCERATION OF VULVA

054.13 HERPETIC INFECTION OF PENIS

054.19 OTHER GENITAL HERPES

054.2 HERPETIC GINGIVOSTOMATITIS

054.3 HERPETIC MENINGOENCEPHALITIS

054.40 HERPES SIMPLEX WITH UNSPECIFIED OPHTHALMIC COMPLICATION

054.41 HERPES SIMPLEX DERMATITIS OF EYELID

054.42 DENDRITIC KERATITIS

054.43 HERPES SIMPLEX DISCIFORM KERATITIS

054.44 HERPES SIMPLEX IRIDOCYCLITIS

054.49 HERPES SIMPLEX WITH OTHER OPHTHALMIC COMPLICATIONS

054.5 HERPETIC SEPTICEMIA

054.6 HERPETIC WHITLOW

054.71 VISCERAL HERPES SIMPLEX

054.72 HERPES SIMPLEX MENINGITIS

054.73 HERPES SIMPLEX OTITIS EXTERNA

054.74 HERPES SIMPLEX MYELITIS

054.79 HERPES SIMPLEX WITH OTHER SPECIFIED COMPLICATIONS

054.8 HERPES SIMPLEX WITH UNSPECIFIED COMPLICATION

054.9 HERPES SIMPLEX WITHOUT COMPLICATION

070.0 VIRAL HEPATITIS A WITH HEPATIC COMA

070.1 VIRAL HEPATITIS A WITHOUT HEPATIC COMA

070.20 VIRAL HEPATITIS B WITH HEPATIC COMA ACUTE OR UNSPECIFIED WITHOUT HEPATITIS DELTA

070.21 VIRAL HEPATITIS B WITH HEPATIC COMA ACUTE OR UNSPECIFIED WITH HEPATITIS DELTA

070.22 CHRONIC VIRAL HEPATITIS B WITH HEPATIC COMA WITHOUT HEPATITIS DELTA

070.23 CHRONIC VIRAL HEPATITIS B WITH HEPATIC COMA WITH HEPATITIS DELTA

070.30 VIRAL HEPATITIS B WITHOUT HEPATIC COMA ACUTE OR UNSPECIFIED WITHOUT HEPATITIS DELTA

070.31 VIRAL HEPATITIS B WITHOUT HEPATIC COMA ACUTE OR UNSPECIFIED WITH HEPATITIS DELTA

070.32 CHRONIC VIRAL HEPATITIS B WITHOUT HEPATIC COMA WITHOUT HEPATITIS DELTA

070.33 CHRONIC VIRAL HEPATITIS B WITHOUT HEPATIC COMA WITH HEPATITIS DELTA

070.41 ACUTE HEPATITIS C WITH HEPATIC COMA

070.42 HEPATITIS DELTA WITHOUT ACTIVE HEPATITIS B DISEASE WITH HEPATIC COMA HEPATITIS DELTA WITH HEPATITIS B CARRIER STATE

070.43 HEPATITIS E WITH HEPATIC COMA

070.44 CHRONIC HEPATITIS C WITH HEPATIC COMA

070.49 OTHER SPECIFIED VIRAL HEPATITIS WITH HEPATIC COMA

070.51 ACUTE HEPATITIS C WITHOUT MENTION OF HEPATIC COMA

070.52 HEPATITIS DELTA WITHOUT ACTIVE HEPATITIS B DISEASE OR HEPATIC COMA

070.53 HEPATITIS E WITHOUT HEPATIC COMA

070.54 CHRONIC HEPATITIS C WITHOUT HEPATIC COMA

070.59 OTHER SPECIFIED VIRAL HEPATITIS WITHOUT HEPATIC COMA

070.6 UNSPECIFIED VIRAL HEPATITIS WITH HEPATIC COMA

070.70 UNSPECIFIED VIRAL HEPATITIS C WITHOUT HEPATIC COMA

070.71 UNSPECIFIED VIRAL HEPATITIS C WITH HEPATIC COMA

070.9 UNSPECIFIED VIRAL HEPATITIS WITHOUT HEPATIC COMA

078.0 MOLLUSCUM CONTAGIOSUM

078.10 VIRAL WARTS UNSPECIFIED

078.11 CONDYLOMA ACUMINATUM

078.12 PLANTAR WART

078.19 OTHER SPECIFIED VIRAL WARTS

078.88 OTHER SPECIFIED DISEASES DUE TO CHLAMYDIAE

079.4 HUMAN PAPILLOMAVIRUS IN CONDITIONS CLASSIFIED ELSEWHERE AND OF UNSPECIFIED SITE

079.50 RETROVIRUS UNSPECIFIED

079.51 HUMAN T-CELL LYMPHOTROPHIC VIRUS TYPE I [HTLV-I]

079.52 HUMAN T-CELL LYMPHOTROPHIC VIRUS TYPE II [HTLV-II]

079.53 HUMAN IMMUNODEFICIENCY VIRUS TYPE 2 [HIV-2]

079.59 OTHER SPECIFIED RETROVIRUS

079.88 OTHER SPECIFIED CHLAMYDIAL INFECTION

090.0 EARLY CONGENITAL SYPHILIS SYMPTOMATIC

090.1 EARLY CONGENITAL SYPHILIS LATENT

090.2 EARLY CONGENITAL SYPHILIS UNSPECIFIED

090.3 SYPHILITIC INTERSTITIAL KERATITIS

090.40 JUVENILE NEUROSYPHILIS UNSPECIFIED

090.41 CONGENITAL SYPHILITIC ENCEPHALITIS

090.42 CONGENITAL SYPHILITIC MENINGITIS

090.49 OTHER JUVENILE NEUROSYPHILIS

090.5 OTHER LATE CONGENITAL SYPHILIS SYMPTOMATIC

090.6 LATE CONGENITAL SYPHILIS LATENT

090.7 LATE CONGENITAL SYPHILIS UNSPECIFIED

090.9 CONGENITAL SYPHILIS UNSPECIFIED

091.0 GENITAL SYPHILIS (PRIMARY)

091.1 PRIMARY ANAL SYPHILIS

091.2 OTHER PRIMARY SYPHILIS

091.3 SECONDARY SYPHILIS OF SKIN OR MUCOUS MEMBRANES

091.4 ADENOPATHY DUE TO SECONDARY SYPHILIS

091.50 SYPHILITIC UVEITIS UNSPECIFIED

091.51 SYPHILITIC CHORIORETINITIS (SECONDARY)

091.52 SYPHILITIC IRIDOCYCLITIS (SECONDARY)

091.61 SECONDARY SYPHILITIC PERIOSTITIS

091.62 SECONDARY SYPHILITIC HEPATITIS

091.69 SECONDARY SYPHILIS OF OTHER VISCERA

091.7 SECONDARY SYPHILIS RELAPSE

091.81 ACUTE SYPHILITIC MENINGITIS (SECONDARY)

091.82 SYPHILITIC ALOPECIA

091.89 OTHER FORMS OF SECONDARY SYPHILIS

091.9 UNSPECIFIED SECONDARY SYPHILIS

092.0 EARLY SYPHILIS LATENT SEROLOGICAL RELAPSE AFTER TREATMENT

092.9 EARLY SYPHILIS LATENT UNSPECIFIED

093.0 ANEURYSM OF AORTA SPECIFIED AS SYPHILITIC

093.1 SYPHILITIC AORTITIS

093.20 SYPHILITIC ENDOCARDITIS OF VALVE UNSPECIFIED

093.21 SYPHILITIC ENDOCARDITIS OF MITRAL VALVE

093.22 SYPHILITIC ENDOCARDITIS OF AORTIC VALVE

093.23 SYPHILITIC ENDOCARDITIS OF TRICUSPID VALVE

093.24 SYPHILITIC ENDOCARDITIS OF PULMONARY VALVE

093.81 SYPHILITIC PERICARDITIS

093.82 SYPHILITIC MYOCARDITIS

093.89 OTHER SPECIFIED CARDIOVASCULAR SYPHILIS

093.9 CARDIOVASCULAR SYPHILIS UNSPECIFIED

094.0 TABES DORSALIS

094.1 GENERAL PARESIS

094.2 SYPHILITIC MENINGITIS

094.3 ASYMPTOMATIC NEUROSYPHILIS

094.81 SYPHILITIC ENCEPHALITIS

094.82 SYPHILITIC PARKINSONISM

094.83 SYPHILITIC DISSEMINATED RETINOCHOROIDITIS

094.84 SYPHILITIC OPTIC ATROPHY

094.85 SYPHILITIC RETROBULBAR NEURITIS

094.86 SYPHILITIC ACOUSTIC NEURITIS

094.87 SYPHILITIC RUPTURED CEREBRAL ANEURYSM

094.89 OTHER SPECIFIED NEUROSYPHILIS

094.9 NEUROSYPHILIS UNSPECIFIED

095.0 SYPHILITIC EPISCLERITIS

095.1 SYPHILIS OF LUNG

095.2 SYPHILITIC PERITONITIS

095.3 SYPHILIS OF LIVER

095.4 SYPHILIS OF KIDNEY

095.5 SYPHILIS OF BONE

095.6 SYPHILIS OF MUSCLE

095.7 SYPHILIS OF SYNOVIUM TENDON AND BURSA

095.8 OTHER SPECIFIED FORMS OF LATE SYMPTOMATIC SYPHILIS

095.9 LATE SYMPTOMATIC SYPHILIS UNSPECIFIED

096 LATE SYPHILIS LATENT

097.0 LATE SYPHILIS UNSPECIFIED

097.1 LATENT SYPHILIS UNSPECIFIED

097.9 SYPHILIS UNSPECIFIED

098.0 GONOCOCCAL INFECTION (ACUTE) OF LOWER GENITOURINARY TRACT

098.10 GONOCOCCAL INFECTION (ACUTE) OF UPPER GENITOURINARY TRACT SITE UNSPECIFIED

098.11 GONOCOCCAL CYSTITIS (ACUTE)

098.12 GONOCOCCAL PROSTATITIS (ACUTE)

098.13 GONOCOCCAL EPIDIDYMO-ORCHITIS (ACUTE)

098.14 GONOCOCCAL SEMINAL VESICULITIS (ACUTE)

098.15 GONOCOCCAL CERVICITIS (ACUTE)

098.16 GONOCOCCAL ENDOMETRITIS (ACUTE)

098.17 GONOCOCCAL SALPINGITIS SPECIFIED AS ACUTE

098.19 OTHER GONOCOCCAL INFECTION (ACUTE) OF UPPER GENITOURINARY TRACT

098.2 GONOCOCCAL INFECTION CHRONIC OF LOWER GENITOURINARY TRACT

098.30 CHRONIC GONOCOCCAL INFECTION OF UPPER GENITOURINARY TRACT SITE UNSPECIFIED

098.31 GONOCOCCAL CYSTITIS CHRONIC

098.32 GONOCOCCAL PROSTATITIS CHRONIC

098.33 GONOCOCCAL EPIDIDYMO-ORCHITIS CHRONIC

098.34 GONOCOCCAL SEMINAL VESICULITIS CHRONIC

098.35 GONOCOCCAL CERVICITIS CHRONIC

098.36 GONOCOCCAL ENDOMETRITIS CHRONIC

098.37 GONOCOCCAL SALPINGITIS (CHRONIC)

098.39 OTHER CHRONIC GONOCOCCAL INFECTION OF UPPER GENITOURINARY TRACT

098.40 GONOCOCCAL CONJUNCTIVITIS (NEONATORUM)

098.41 GONOCOCCAL IRIDOCYCLITIS

098.42 GONOCOCCAL ENDOPHTHALMIA

098.43 GONOCOCCAL KERATITIS

098.49 OTHER GONOCOCCAL INFECTION OF EYE

098.50 GONOCOCCAL ARTHRITIS

098.51 GONOCOCCAL SYNOVITIS AND TENOSYNOVITIS

098.52 GONOCOCCAL BURSITIS

098.53 GONOCOCCAL SPONDYLITIS

098.59 OTHER GONOCOCCAL INFECTION OF JOINT

098.6 GONOCOCCAL INFECTION OF PHARYNX

098.7 GONOCOCCAL INFECTION OF ANUS AND RECTUM

098.81 GONOCOCCAL KERATOSIS (BLENNORRHAGICA)

098.82 GONOCOCCAL MENINGITIS

098.83 GONOCOCCAL PERICARDITIS

098.84 GONOCOCCAL ENDOCARDITIS

098.85 OTHER GONOCOCCAL HEART DISEASE

098.86 GONOCOCCAL PERITONITIS

098.89 GONOCOCCAL INFECTION OF OTHER SPECIFIED SITES

099.0 CHANCROID

099.1 LYMPHOGRANULOMA VENEREUM

099.2 GRANULOMA INGUINALE

099.3 REITER'S DISEASE

099.40 OTHER NONGONOCOCCAL URETHRITIS UNSPECIFIED

099.41 OTHER NONGONOCOCCAL URETHRITIS CHLAMYDIA TRACHOMATIS

099.49 OTHER NONGONOCOCCAL URETHRITIS OTHER SPECIFIED ORGANISM

099.50 OTHER VENEREAL DISEASES DUE TO CHLAMYDIA TRACHOMATIS UNSPECIFIED SITE

099.51 OTHER VENEREAL DISEASES DUE TO CHLAMYDIA TRACHOMATIS PHARYNX

099.52 OTHER VENEREAL DISEASES DUE TO CHLAMYDIA TRACHOMATIS ANUS AND RECTUM

099.53 OTHER VENEREAL DISEASES DUE TO CHLAMYDIA TRACHOMATIS LOWER GENITOURINARY SITES

099.54 OTHER VENEREAL DISEASES DUE TO CHLAMYDIA TRACHOMATIS OTHER GENITOURINARY SITES

099.55 OTHER VENEREAL DISEASES DUE TO CHLAMYDIA TRACHOMATIS UNSPECIFIED GENITOURINARY SITE

099.56 OTHER VENEREAL DISEASES DUE TO CHLAMYDIA TRACHOMATIS PERITONEUM

099.59 OTHER VENEREAL DISEASES DUE TO CHLAMYDIA TRACHOMATIS OTHER SPECIFIED SITE

099.8 OTHER SPECIFIED VENEREAL DISEASES

099.9 VENEREAL DISEASE UNSPECIFIED

104.0 NONVENEREAL ENDEMIC SYPHILIS

131.00 UROGENITAL TRICHOMONIASIS UNSPECIFIED

131.02 TRICHOMONAL URETHRITIS

131.03 TRICHOMONAL PROSTATITIS

131.09 OTHER UROGENITAL TRICHOMONIASIS

131.8 TRICHOMONIASIS OF OTHER SPECIFIED SITES

131.9 TRICHOMONIASIS UNSPECIFIED

290.10 PRESENILE DEMENTIA UNCOMPLICATED

290.11 PRESENILE DEMENTIA WITH DELIRIUM

290.12 PRESENILE DEMENTIA WITH DELUSIONAL FEATURES

290.13 PRESENILE DEMENTIA WITH DEPRESSIVE FEATURES

293.0 DELIRIUM DUE TO CONDITIONS CLASSIFIED ELSEWHERE

293.1 SUBACUTE DELIRIUM

294.8 OTHER PERSISTENT MENTAL DISORDERS DUE TO CONDITIONS CLASSIFIED ELSEWHERE

296.82 ATYPICAL DEPRESSIVE DISORDER

310.1 PERSONALITY CHANGE DUE TO CONDITIONS CLASSIFIED ELSEWHERE

331.0 ALZHEIMER'S DISEASE

331.2 SENILE DEGENERATION OF BRAIN

331.9 CEREBRAL DEGENERATION UNSPECIFIED

356.0 HEREDITARY PERIPHERAL NEUROPATHY

356.9 UNSPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY

389.10 SENSORINEURAL HEARING LOSS UNSPECIFIED

604.0 ORCHITIS EPIDIDYMITIS AND EPIDIDYMO-ORCHITIS WITH ABSCESS

604.90 ORCHITIS AND EPIDIDYMITIS UNSPECIFIED

604.91 ORCHITIS AND EPIDIDYMITIS IN DISEASES CLASSIFIED ELSEWHERE

614.0 ACUTE SALPINGITIS AND OOPHORITIS

614.1 CHRONIC SALPINGITIS AND OOPHORITIS

614.2 SALPINGITIS AND OOPHORITIS NOT SPECIFIED AS ACUTE SUBACUTE OR CHRONIC

614.3 ACUTE PARAMETRITIS AND PELVIC CELLULITIS

614.4 CHRONIC OR UNSPECIFIED PARAMETRITIS AND PELVIC CELLULITIS

614.5 ACUTE OR UNSPECIFIED PELVIC PERITONITIS FEMALE

614.6 PELVIC PERITONEAL ADHESIONS FEMALE (POSTOPERATIVE) (POSTINFECTION)

614.7 OTHER CHRONIC PELVIC PERITONITIS FEMALE

614.8 OTHER SPECIFIED INFLAMMATORY DISEASE OF FEMALE PELVIC ORGANS AND TISSUES

614.9 UNSPECIFIED INFLAMMATORY DISEASE OF FEMALE PELVIC ORGANS AND TISSUES

615.0 ACUTE INFLAMMATORY DISEASES OF UTERUS EXCEPT CERVIX

615.1 CHRONIC INFLAMMATORY DISEASES OF UTERUS EXCEPT CERVIX

615.9 UNSPECIFIED INFLAMMATORY DISEASE OF UTERUS

616.0 CERVICITIS AND ENDOCERVICITIS

616.10 VAGINITIS AND VULVOVAGINITIS UNSPECIFIED

616.11 VAGINITIS AND VULVOVAGINITIS IN DISEASES CLASSIFIED ELSEWHERE

616.2 CYST OF BARTHOLIN'S GLAND

616.3 ABSCESS OF BARTHOLIN'S GLAND

616.4 OTHER ABSCESS OF VULVA

616.50 ULCERATION OF VULVA UNSPECIFIED

616.51 ULCERATION OF VULVA IN DISEASES CLASSIFIED ELSEWHERE

616.81 MUCOSITIS (ULCERATIVE) OF CERVIX, VAGINA, AND VULVA

616.89 OTHER INFLAMMATORY DISEASE OF CERVIX, VAGINA AND VULVA

616.9 UNSPECIFIED INFLAMMATORY DISEASE OF CERVIX VAGINA AND VULVA

760.2 MATERNAL INFECTIONS AFFECTING FETUS OR NEWBORN

781.2 ABNORMALITY OF GAIT

782.1 RASH AND OTHER NONSPECIFIC SKIN ERUPTION

785.6 ENLARGEMENT OF LYMPH NODES

V01.6 CONTACT WITH OR EXPOSURE TO VENEREAL DISEASES

V02.7 CARRIER OR SUSPECTED CARRIER OF GONORRHEA

V02.8 CARRIER OR SUSPECTED CARRIER OF OTHER VENEREAL DISEASES

V08 ASYMPTOMATIC HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION STATUS

 

 

Documentation Requirements

• Documentation supporting the medical necessity of this procedure must be kept on the provider’s record and available to be furnished upon request.

o Failure to do so may result in rejection or denial of claim(s).

o This document should include but is not limited to: history and physical examination, notes documenting evaluation and management with relevant clinical signs, symptoms or abnormal laboratory test results.

o The patient's clinical record should further indicate changes/alterations and response or non-response in medications prescribed for the treatment of the patient's condition.

• It is understood that any diagnosis information submitted must have (in the patient record) medical justification for components of the procedure.

o Subsequent determination that the medical record is lacking such justification will result in a retroactive denial under 1862(a)(1)(A)

 

Sources of Information and Basis for Decision

 

Revision 3: CPT 2008 ICD-9-CM 2008

 

Other Contractors LCD's

 

NIH

 

HHS

 

NIAID

 

Articles: JClin Microbiol 2003; 41:250-253: Evaluation of an enzyme immunoassay technique for detection of antibodies against Treponema pallidum.

Mayo Foundation for Clinical Education and Research (MFMER) Syphillis

J Clin Microbiol1991 March;29(3):444-448 Specific Immunofluorescence staining of Treponema Pallidum in smears and tissues.

HSJethwa, JL Schmitz, GDallabetta, F Behets, I Hoffmann et alComparison of molecular and microscopic techniques for detection of Treponema pallidum in genital ulcers.

CDC Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB prevention

 

- ICD-9-CM, 2005

 

- CPT-2000

 

- ICD-9-CM, 1999

 

- CDC’s Guidelines for Treatment of Sexually Transmitted Disease, 1998

 

- CMD Clinical Laboratory Workgroup

 

- Current Medical Literature

 

01/01/2010

The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

AMA CPT / ADA CDT Copyright Statement

CPT codes, descriptions and other data only are copyright 2012 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

 

CMS LCD L29416 SYPHILIS TEST

 

Copyright 2006-2018 Automated Clinical Guidelines, LLC. All rights reserved.