HIV: ICD-10 Dx. Coding
- By John Verhovshek
- In Coding
- April 26, 2016
- 8 Comments
HIV infection/illness is coded as a diagnosis only for confirmed cases. Confirmation does not require documentation of a positive blood test or culture for HIV; the physician’s diagnostic statement that the patient is HIV positive or has an HIV-related illness is sufficient.
In the inpatient setting, HIV is the only condition that must be confirmed to select the code. All other conditions documented as “probable,” suspected,” likely,” “questionable,” “probable,” or “still to rule out” are coded as if they exist in the inpatient setting.
The proper sequencing for HIV depends on the reason for the admission or encounter. When a patient is admitted for an HIV-related condition, sequence B20 Human immunodeficiency virus [HIV] disease first, followed by additional diagnosis codes for all reported HIV-related conditions. Conditions always considered HIV-related include Kaposi’s sarcoma, lymphoma, Pneumocystis carinii pneumonia (PCP), cryptococcal meningitis, and cytomegaloviral disease. These conditions are considered opportunistic infections.
If a patient with HIV disease is admitted for an unrelated condition (e.g., fracture), sequence the code for the unrelated condition, first. Report B20 as an additional diagnosis, along with any HIV-related conditions.
Apply Z21 Asymptomatic human immunodeficiency virus [HIV] infection status when the patient is HIV positive and does not have any documented symptoms of an HIV-related illness. Do not use this code if the term AIDS is used. If the patient is treated for any HIV-related illness, or is described as having any condition resulting from HIV positive status, use B20.
Patients with inconclusive HIV serology, and no definitive diagnosis or manifestations of the illness, may be assigned code R75 Inconclusive laboratory evidence of human immunodeficiency virus [HIV].
Known prior diagnosis of an HIV-related illness should be coded to B20. After a patient has developed an HIV-related illness, the patient’s condition should be assigned code B20 on every subsequent admission/encounter. Never assign R75 or Z21 to a patient with an earlier diagnosis of AIDS or symptomatic HIV (B20).
If a patient is being seen to determine HIV status, use code Z11.4 Encounter for screening for human immunodeficiency virus [HIV]. Should a patient with signs, symptoms or illness, or a confirmed HIV-related diagnosis be tested for HIV, code the signs and symptoms or the diagnosis. If the results are positive and the patient is symptomatic, report B20 with codes for the HIV-related symptoms or diagnosis. The HIV counseling code (Z71.7) may be used if counseling is provided for patients with positive test results. When a patient believes that he/she has been exposed to or has come into contact with the HIV virus, report Z20.6.
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Influenza due to certain identified influenza viruses and influenza due to other identified influenza are also an exception to the rule that allows possible conditions to be coded as if proven for inpatient status cases. Influenza codes from categories J09 and J10) must be confirmed before they can be assigned. Reference Coding Guidelines #10. Chapter 10. c.
Thank you very much for this information John. It’s very helpful!
Symptomatic HIV can be coded as AIDS it’s a new information for inpatient coding.
Thnak you for the information.
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Thank you for this clarification John. It has always been my understanding that B20 or Z21 are to be coded first under all circumstances.
According to definition Z21
A condition caused by an infection with human immunodeficiency virus. This condition is characterized by fever, swollen lymph nodes, sore throat, or rash………. you can check @ http://medicbind.com/codes/Z00-Z99/Z20-Z29/Z21.-/Z21
Our ID docs are stating that patient had an HIV associated condition in 2009 (PCP) but has been well controlled since with an undetectable viral load and CD4 count of 840 (normal) and he states that the current pneumonia is community acquired. I feel like this MD is telling us that the CAP on this admission is NOT related to his HIV/AIDS and then would be sequenced first? We see this more and more since HAART is allowing patients to have normal or near normal CD4 counts and viral loads that can’t even be detected!
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