AIDS vs HIV

burtosh0

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:confused::confused:

I have a providers that are documenting. My question is, B20 or Z21?

"HIV follow up
There are no AIDS defining criteria. There are no associated symptoms. Comments: Has no new concerns today.

Patient is taking:
[/B]Isentress (raltegravir) is an antiviral medicine that prevents human immunodeficiency virus (HIV) from multiplying in your body. Isentress is used to treat HIV, the virus that can cause the acquired immunodeficiency syndrome (AIDS)

and

Viramune

Nevirapine is an antiviral medication that prevents human immunodeficiency virus (HIV) cells from multiplying in your body. Nevirapine is used to treat HIV, which causes the acquired immunodeficiency syndrome (AIDS). Nevirapine will not prevent or cure HIV or AIDS.

Thanks in advance!
 

CodingKing

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HIV. This information is in the guidelines. Unless physician says the patient has AIDS or diagnosed with an aids related condition its asymptomatic HIV.

HIV follow up
There are no AIDS defining criteria. There are no associated symptoms. Comments: Has no new concerns today.
 
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burtosh0

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Thank you. Yes, but my medical director is stating that even though the medical records states, "no AIDS criteria met", as long as the patient is on the retroviral medications, then that patient has AIDS. I am not debating the clinical aspect, just the coding documentation aspect. After reading the above documentation would you allow the provider to code B20 or Z21?
 
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Thank you. Yes, but my medical director is stating that even though the medical records states, "no AIDS criteria met", as long as the patient is on the retroviral medications, then that patient has AIDS. I am not debating the clinical aspect, just the coding documentation aspect. After reading the above documentation would you allow the provider to code B20 or Z21?

"no AIDS criteria met" is another way of saying it's not an AIDS diagnosis. The use of antiretroviral meds doesn't justify a diagnosis of AIDS on its own. I think the medical director is making a blanket-statement in this case. For example, a patient takes Valtrex every day to prevent outbreaks. Usually it's discovered that the patient has the condition which prompts the use of the Valtrex. However, it's certainly possible that a person can test positive for a certain type of herpes, say during an STD screening, and starts taking the Valtrex to try to prevent any outbreaks from happening, even though they haven't had one nor do they know that they will ever get an outbreak. More than likely the meds probably came into play after an illness/outbreak, but it would be inaccurate to assume that's the case for everybody, if that makes sense.

"HIV is treated using a combination of medicines to fight HIV infection. This is called antiretroviral therapy (ART). ART isn’t a cure, but it can control the virus so that you can live a longer, healthier life and reduce the risk of transmitting HIV to others. ART is recommended for all people with HIV, regardless of how long they’ve had the virus or how healthy they are. If left untreated, HIV will attack the immune system and eventually progress to AIDS."

"Treatment with antiretroviral drugs does not necessarily mean a patient has progressed from HIV-positive status to full-blown AIDS, since the CDC recommends that all HIV-positive patients be treated with antiretrovirals."

Even though the narrative states no complaints, the diagnosis would really depend on the history of the HIV. If it has always been asymptomatic, then Z21 would be accurate. The use of antiretrovirals alone can't really be used to define a B20 diagnosis because a patient may have always been asymptomatic and is taking the meds proactively in a sense. There would need to be a documented linkage between the use of the meds AND a previous HIV related illness to meet the criteria for B20.

In my opinion, based on the narrative, there is nothing documented to substantiate using B20. The use of the meds is irrelevant without further elaboration as I mentioned above.
 

CodingKing

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I am not debating the clinical aspect, just the coding documentation aspect.

Correct. This information is from the ICD coding guidelines. Being on retroviral medication is not part of the ICD criteria for reporting B20.


I.C.1.a.2.d

Z21, Asymptomatic human immunodeficiency virus [HIV] infection status, is to be applied 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 his/her HIV positive status; use B20 in these cases.

The notes do not indicate that the patient has AIDS. It looks to be worded in a way to be extremely clear that the patient has no Symptoms of AIDS. Until the patient has had their first AIDS related condition they are only HIV positive. As mentioned above, being on antivirals for HIV doesn't qualify someone as having AIDS.


Where clinical vs ICD guidelines gets murky is when a patient has their first AIDS related condition and it goes away, they are still considered as having AIDS even though they no longer exhibit symptoms (some docs think patients can go back and forth but the I10 guidelines override).

I.C.1.a.2.f

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. Patients previously diagnosed with any HIV illness (B20) should never be assigned to R75 or Z21, Asymptomatic human immunodeficiency virus [HIV] infection status.

Nothing in the current note indicates a history of an AIDS defining illness in fact where the doc wrote "There are no AIDS defining criteria" is pretty clear that they are trying to say no past history of B20 meaning Z21 is correct
 
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