Z11.2 — Encounter for screening for other bacterial diseases
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- A claim submitted without a valid ICD-10-CM diagnosis code will be returned as an incomplete claim under Section 1833(e) of the Social Security Act; diagnosis must best describe the patient's condition for which the service was performed.
- For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
- For diagnostic (non-screening) use of the test, report the test result if known; if result is not available, report the symptoms prompting the test.
- When billing CPT 87641 for screening purposes (statutorily non-covered), ICD-10-CM diagnosis codes may be reported but payment will still be denied.
Key Coverage Criteria
- Direct DNA probe assays (e.g., Affirm VP/VP III) for detection of Trichomonas vaginalis, Candida species, and Gardnerella vaginalis for members WITH SYMPTOMS OF VAGINITIS
- Measurement of sialidase activity in vaginal fluid (e.g., BVBlue test) for WOMEN WITH SYMPTOMS OF VAGINITIS
- Testing of vaginal pH and testing for presence of amines (e.g., FemExam) for WOMEN WITH SYMPTOMS OF VAGINITIS
- Nucleic acid amplification (PCR/NAAT) tests for diagnosis of bacterial vaginosis (examples: BD MAX Vaginal Panel, Aptima BV, NuSwab VG, OneSwab BV Panel PCR with Lactobacillus Profiling, SureSwab BV) in WOMEN WITH SYMPTOMS OF VAGINITIS
- Nucleic acid amplification (PCR/NAAT) tests for diagnosis of Candida vaginitis (detection of Candida albicans, glabrata, krusei, parapsilosis, tropicalis) in WOMEN WITH SYMPTOMS OF VAGINITIS (examples: BD MAX vaginitis panel, GenPath GenPap, INFINITI Candida Vaginosis QUAD Assay, LabCorp NuSwab, MDL OneSwab, Quest SureSwab)
- Screening for Trichomonas vaginalis with NAAT, direct probe, or antigen detection tests for WOMEN WITH RISK FACTORS (examples: new or multiple partners; history of sexually transmitted diseases; exchange of sex for payment; injection drug use)
6 Active Policies
A52379 — Billing and Coding: CPT Code 87641 (Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique)
J06
AMBETTER-CP.MP.97 — Testing for Select Genitourinary Conditions
CIGNA-0398 — Transvaginal Ultrasound, Non-Obstetrical - (0398)
AETNA-CPB-0177 — Helicobacter Pylori Infection Testing
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.