Follow ICD-9-CM Guidelines: Simplify HIV and AIDS Coding
Make Assigning HIV and AIDS Diagnosis Codes Straight Forward.
By Katherine Abel, CPC, CPMA, CPC-I, CMRS
Assigning ICD-9-CM codes for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) isn’t as straightforward as it initially appears. Observing a few simple but very important rules outlined in the ICD-9-CM Official Coding Guidelines (section I. C., chapter 1.a) will ensure your diagnosis coding is accurate.
1. V Codes for Asymptomatic Screening
When an asymptomatic patient is seen to determine HIV status, the appropriate diagnosis is V73.89 Screening for other specified viral disease. You also may report V69.8 Other problems related to lifestyle as a secondary code if an asymptomatic patient is in a known high-risk group for HIV.
2. Report Signs and Symptoms, if Present
When a patient with signs, symptoms, or illness, or a confirmed HIV-related diagnosis, is tested for HIV, you may report the signs/symptoms/illness or related diagnosis, rather than screening V codes. For example, a patient visits the physician for cutaneous lesions on the face and trunk. After biopsy, the physician determines the patient has Kaposi’s Sarcoma. The patient is tested for HIV and the results are positive. In this case, report 042 Human immunodeficiency virus (HIV) disease and 176.0 Kaposi’s sarcoma of the skin.
3. Different Codes Apply for Symptomatic, Asymptomatic, and Inconclusive Results
If HIV testing returns positive for a symptomatic patient, report 042.
Assign V08 Asymptomatic human immunodeficiency virus (HIV) infection when the patient is HIV positive and does not have any documented symptoms of an HIV-related illness. Do not assign V08 if the term AIDS is used, if the patient is treated for any HIV-related illness, or is described as having a condition resulting from HIV-positive status. In these cases, report 042.
Patients with inconclusive HIV serology, but not a definitive diagnosis or manifestation of the illness, may be assigned 795.71 Nonspecific serologic test for human immunodeficiency virus (HIV).
The HIV counseling code (V65.44 Human immunodeficiency virus (HIV) counseling) may be used if counseling is provided for patients with either negative or positive test results.
4. Report Only Confirmed Cases
Do not report HIV if the diagnosis has not been confirmed. In the inpatient setting for facility diagnosis coding, it is appropriate to report suspected or ruled out diagnoses as if the condition does exist. HIV is an exception to this rule: HIV is the only condition that must be confirmed if it is to be reported in the inpatient setting.
Confirmation does not require documentation of positive serology or culture for HIV. The physician’s diagnostic statement that the patient is HIV positive or has an HIV-related illness is sufficient.
After a patient has developed an HIV-related illness, the patient’s condition should be assigned code 042 on every subsequent admission/encounter. Never assign 795.71 or V08 to the condition of a patient with an earlier diagnosis of HIV (042).
5. Sequence Diagnoses by Relevance
When a patient is seen for an HIV-related condition, 042 is sequenced first, followed by additional diagnosis codes for all reported HIV-related conditions. For example, a patient with AIDS has developed acute myocarditis as a manifestation of AIDS and is being seen in the office for the myocarditis. The appropriate ICD-9-CM codes are 042 as primary and 422.0 Acute myocarditis in diseases classified elsewhere as the secondary diagnosis code.
If a patient with HIV disease is admitted for an unrelated condition (for instance, fracture), the code for the unrelated condition is sequenced first. Code 042 is reported as an additional diagnosis, as are any HIV-related conditions. For example, an HIV patient is seen for a sprained ankle. The sprained ankle is coded as the first diagnosis, 845.00 Sprains of ankle and foot, ankle, unspecified site. The secondary diagnosis would be 042, followed by additional diagnosis codes for all reported HIV-related conditions. Provider documentation must support the HIV diagnosis.
6. Pregnancy Takes Sequencing Priority
Asymptomatic HIV infection status during pregnancy, childbirth, or the puerperium should be coded using V08 and 647.6X Other viral illnesses in the mother, classifiable elsewhere, but complicating the pregnancy, childbirth, or the puerperium. Codes from chapter 15 always take sequencing priority.
When a pregnant patient is treated for an HIV-related illness, the first-listed diagnosis is 647.6x, followed by 042 and the codes for the HIV-related illness.
Katherine Abel, CPC, CPMA, CPC-I, CMRS, is the director of curriculum for AAPC. A prior health care consultant, Katherine has over 15 years of practical experience working in health care, including extensive work with billing offices, insurance carriers, and provider offices. Katherine’s experience includes responsibility over coding, compliance, reimbursement, and technology initiatives.