December Brings AIDS Awareness to the World
Know the stages of HIV, prevention, detection, and its associated conditions for proper coding and better patient care.
With Dec. 1 being World AIDS Day, the topic of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) is on the minds of people all over the globe. Although AIDS-related deaths have been reduced by more than 55 percent since the peak in 2004, according to The Joint United Nations Program on HIV/AIDS (UNAIDS), the disease remains an epidemic. In 2018, UNAIDS reports that, worldwide, 1.7 million people became newly infected with HIV, 37.9 million people were living with HIV, and 770,000 people died from AIDS-related illnesses.
HIV is the virus that can lead to AIDS if left untreated. HIV attacks the immune system’s CD4 cells, commonly known as T-cells, which are a major part of the body’s defense system to fight infections. If HIV is not treated, the number of CD4 cells is reduced so much that the immune system is compromised, placing the infected person at increased risk for other infections and infection-related cancers. As time passes, so many CD4 cells are destroyed that the body is incapable of fighting off infection and disease, which leads to opportunistic infections and cancers, signaling that the person has AIDS — the final stage of HIV infection.
3 Stages of HIV Infection
Stage 1: Acute HIV infection – During this stage, people have a large viral load and are very contagious. Many people do not know that they’ve contracted the virus at this stage because they don’t immediately feel sick; in fact, some do not feel sick at all in this phase. About two-thirds of people infected will experience a flu-like illness within two to four weeks after infection.
Stage 2: Clinical latency (HIV inactivity or dormancy) – This stage is often referred to as asymptomatic HIV infection or chronic HIV infection. In this phase, HIV is active but reproduces at a very slow rate. Those who are compliant with HIV treatment medications can stay in this phase for several decades. Those who are not compliant with treatment may stay in this phase for a decade or longer; however, some progress through this phase more quickly.
The ICD-10-CM code for stages one and two is Z21 Asymptomatic human immunodeficiency virus [HIV] infection status.
Stage 3: AIDS – AIDS is the most severe stage of HIV infection. The immune system is so severely damaged that an increasing number of opportunistic illnesses plague the infected person. If left untreated, people with AIDS typically survive for about three years. As with stage one, those with AIDS can have a high viral load and can be very contagious.
The ICD-10-CM code for stage three is B20 Human immunodeficiency virus [HIV] disease.
ICD-10-CM guideline C.1.a.1 states that only confirmed cases of HIV should be coded. In this context, “confirmation” does not require documentation of positive serology or culture for HIV; the provider’s diagnostic statement that the patient is HIV positive or has an HIV-related illness is sufficient.
ICD-10-CM guideline C.1.a.2.d states to apply Z21 when the patient, without any documentation of symptoms, is listed as being “HIV positive,” “known HIV,” “HIV test positive,” or similar terminology. Do not use this code if the term “AIDS” is used or if the patient is treated for any HIV-related illness or is described as having any condition(s) resulting from an HIV-positive status.
ICD-10-CM guideline C.1.a.2.f states that patients with any known prior diagnosis of an HIV-related illness should be coded to B20. Once a patient has developed an HIV-related illness, the patient should always be assigned code B20 on every subsequent admission/encounter.
Diagnosis Codes for HIV-Related Conditions
Some HIV-related conditions include:
- Candidiasis of trachea, lungs, bronchi, or esophagus: Category B37 Candidiasis
- Cervical cancers: Category C53 Malignant neoplasm of cervix uteri
- Coccidioidomycosis: Category B38 Coccidioidomycosis
- Cryptococcosis: Category B45 Cryptococcosis
- Cryptosporidiosis, chronic intestinal: A07.2 Cryptosporidiosis
- Cytomegalovirus diseases: Category B25 Cytomegaloviral disease
- Encephalopathy, HIV-related: G93.49 Other encephalopathy
- Herpes simplex: B00.9 Herpesviral infection, unspecified
- Histoplasmosis: Category B39 Histoplasmosis
- Isosporiasis, chronic intestinal: A07.3 Isosporiasis
- Kaposi’s sarcoma: Category C46 Kaposi’s sarcoma
- Lymphoma: Categories C81-C96 (Malignant neoplasms of lymphoid, hematopoietic and related tissue)
- Tuberculosis: Categories A15-A19 (Tuberculosis)
- Pneumocystis carinii pneumonia: B59 Pneumocystosis
- Progressive multifocal leukoencephalopathy: A81.2 Progressive multifocal leukoencephalopathy
- Salmonella septicemia, recurrent: A02.1 Salmonella sepsis
- Toxoplasmosis of the brain: B58.2 Toxoplasma meningoencephalitis
- Wasting syndrome due to HIV: R64 Cachexia
ICD-10-CM guideline C.1.a.2.a states that if a patient is admitted for an HIV-related condition, the principal diagnosis should be B20, followed by additional diagnosis codes for all reported HIV-related conditions.
ICD-10-CM guideline C.1.a.2.b states that if a patient with HIV disease is admitted for an unrelated condition (such as a traumatic injury), the code for the unrelated condition (for example, the nature of injury code) should be the principal diagnosis. The secondary diagnosis is B20, followed by additional diagnosis codes for all reported HIV-related conditions.
Explore HIV Etiology
HIV is categorized into two types: HIV-1 and HIV-2. Most HIV infections in the world are classified as HIV-1; HIV-2 is mainly confined to people in or from West Africa. Both types of HIV are transmitted in the same ways and can cause AIDS; however, HIV-2 is less virulent and less likely to cause AIDS due to a longer asymptomatic stage.
The originating source of HIV infection in humans has been linked to a type of Central African chimpanzee. Scientists believe that the chimpanzee version of the virus, simian immunodeficiency virus (SIV), was probably transmitted to humans when chimpanzees were hunted for meat, causing humans to be in contact with their infected blood. HIV is most commonly spread from person to person by:
- Participating in anal or vaginal sex with someone who has HIV without safety precautions such as condoms or medications used to prevent or treat HIV
- Sharing needles, rinse water, or other equipment used to prepare injectable drugs with someone who has HIV
- Transmitting the disease from infected mother to child during pregnancy, birth, or breastfeeding
- Being stuck with a needle or sharp object that is contaminated with HIV
There is currently no effective cure for HIV, but it can be controlled with antiretroviral therapy (ART). If ART is taken as prescribed, a person’s viral load can become undetectable. If it remains undetectable, life expectancy can be nearly equal to those who do not have HIV, with effectively no risk of spreading HIV infection to an HIV-negative sex partner.
Coding HIV Screening and Pathology
The Centers for Disease Control and Prevention (CDC) recommends everyone between the ages of 13 and 64 gets tested for HIV at least once as part of routine healthcare, and at least once a year for those who are at higher risk. HIV tests are typically performed on blood or oral fluid but can also be performed on urine. There are three types of HIV tests available: nucleic acid tests (NAT), antigen/antibody tests, and antibody tests.
A nucleic acid test looks for HIV in the blood. The test can yield either a negative or positive result or a viral load result. A NAT can typically detect HIV infection 10 to 33 days after exposure. There are six CPT® codes for reporting NAT testing for HIV infection. Code selection is based on whether testing is done to detect HIV-1 or HIV-2 and the specific laboratory technique used for testing.
87534 Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, direct probe technique
87537 Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, direct probe technique
87535 Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, amplified probe technique, includes reverse transcription when performed
87538 Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, amplified probe technique, includes reverse transcription when performed
87536 Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, quantification, includes reverse transcription when performed
87539 Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, quantification, includes reverse transcription when performed
An antigen/antibody test looks for both antibodies and HIV antigens. The immune system produces antibodies when exposed to a pathogen. Antigens are foreign substances that activate the immune system. This type of test can typically detect HIV infection 18 to 45 days after exposure. There are three CPT® codes for reporting antigen/antibody testing for HIV infection. Code selection is based on whether testing is done to detect HIV-1, HIV-2, or both.
87389 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result
87390 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; HIV-1
87391 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; HIV-2
Most rapid tests and home testing kits are antibody tests. This type of test looks for antibodies to HIV in bodily fluids. Antibody tests can take 23 to 90 days to reliably detect HIV infection after exposure. If an antibody test yields a positive result, a follow-up test is needed to confirm the results. There are three CPT® codes for reporting antibody testing for HIV infection. Code selection is based on whether testing is done to detect HIV-1, HIV-2, or both.
86701 Antibody; HIV-1
86702 Antibody; HIV-2
86703 Antibody; HIV-1 and HIV-2, single result
ICD-10-CM guideline C.1.a.2.h states that if a patient is being seen to determine HIV status, use code Z11.4 Encounter for screening for human immunodeficiency virus [HIV]. Use additional codes for any associated high-risk behavior.
If a patient with signs or symptoms is being seen for HIV testing, code the signs and symptoms. An additional counseling code, Z71.7 Human immunodeficiency virus [HIV] counseling, may be used if counseling is provided during the encounter for the test. Also, use Z71.7 when a patient returns to be informed of their HIV test results and the test result is negative.
If the results of an HIV test are inconclusive, meaning insufficient or indeterminate, ICD-10-CM guideline C.1.a.2.e states to use code R75 Inconclusive laboratory evidence of human immunodeficiency virus [HIV]. Insufficient means that there was a problem with the sample that prevented it from being tested. Indeterminate means the test did not yield a definite negative or positive result.
Code Z20.6 Contact with and (suspected) exposure to human immunodeficiency virus [HIV] may be used to report suspected HIV exposure.
HIV Has Come a Long Way Since the ’80s
The medical community has made some amazing breakthroughs since the CDC’s first reported cases of AIDS in 1981. HIV infection rates are on a steady decline worldwide due to many factors — one being counseling and testing initiatives. A diagnosis of HIV is no longer a guaranteed death sentence, as it once was. While there is still no effective cure, early detection and medical treatment compliance can lead to a long, healthy life for a person with HIV. An HIV diagnosis is a very important part of a medical record and insurance claim; however, due to its inherent complication of any care provided to a patient.
About the author:
Victoria Wheeler, CPC, CRC, CPPM, is the coding supervisor in the department of neurology at Washington University School of Medicine and the member development officer of the St. Louis East, Mo., local chapter.
UNAIDS. Global HIV & AIDS statistics 2019 fact sheet.
ICD-10-CM Official Guidelines for Coding and Reporting, FY 2020.