Email not displaying correctly? View it in your browser.

Issue #41 - November 8, 2013

AAPC ICD-10 Tips and Resources

IN THIS ISSUE

Featured Article
In the News
Coding Snapshot
ICD-10 Strategies
ICD-10 Resource


ICD-10 EDUCATION

Code Set Boot Camps:
Houston, TX 11/14
Portland, OR 11/21
Charlotte, NC 11/21
SLC, UT 12/5
VIEW ALL

Implementation Boot Camps

Anatomy & Pathophysiology Online

Code Set Training

FEATURED ARTICLE

HIV/AIDS Coding in ICD-10-CM

In addition to the general coding guidelines, there are chapter-specific guidelines for almost every chapter located in Section I.C of the code book. In this article, coding of HIV/AIDS, along with the guidelines regarding it, will be covered.

The codes that will mainly be assigned for HIV/AIDS in ICD-10-CM are as follows:

  • B20 Human immunodeficiency virus (HIV) disease
  • Z21 Asymptomatic human immunodeficiency virus (HIV) infection status
  • Z20.6 Contact with and (suspected) exposure to human immunodeficiency virus (HIV)
  • Z71.7 Human immunodeficiency virus (HIV) counseling
  • Z11.4 Encounter for screening for human immunodeficiency virus (HIV)
  • R75 Inconclusive laboratory evidence of human immunodeficiency virus (HIV)

The guidelines are located specifically in section I.C.1 under Chapter 1, Certain Infectious and Parasitic Diseases (I.C.1.a.1 – I.C.1.a.2.h). According to the diagnostic coding and reporting guidelines for outpatient services (IV.H), uncertain diagnoses should not be coded, but three times in the chapter-specific guidelines, this guideline is repeated. The first time is in the guidelines for HIV/AIDS where it states to code only confirmed cases of HIV infection/illness (I.C.1.a.1). It further states that confirmation does not require documentation of positive serology or culture for HIV, but that the provider's diagnostic statement that the patient is HIV positive or has an HIV-related condition.

If a patient is admitted for an HIV-related condition, the first-listed diagnosis should be B20 followed by additional diagnosis codes for all reported HIV-related conditions (I.C.1.a.2.a).

EXAMPLE:

An HIV patient presented to the clinic with what he thought was bruising. A biopsy was performed and a diagnosis of Kaposi's sarcoma of the skin is confirmed.

B20 Human immunodeficiency virus (HIV) disease

C46.0 Kaposi's sarcoma of skin

There is an instructional note under category C46, Kaposi's sarcoma, which reinforces the guideline by stating to code first any human immunodeficiency virus (HIV) disease (B20).

If a patient is admitted for an unrelated condition, the code for the unrelated condition should be the first-listed diagnosis. Other diagnoses would be B20 followed by additional diagnosis codes for all reported HIV-related conditions (I.C.a.2.b).

EXAMPLE:

A patient presents for a check up for his acute diastolic congestive heart failure. He also has AIDS.

I50.31 Acute diastolic (congestive) heart failure

B20 Human immunodeficiency virus (HIV) disease

In this case, the patient is being seen for his CHF, which is not related to his AIDS, so the CHF is coded first, followed by the code for AIDS.

Once a patient has been diagnosed with AIDS, code B20 should be assigned from that encounter forward. The guideline (I.C.1.a.2.f) states that a patient 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 or encounter.

EXAMPLE:

A patient with a past HIV-related infection presents to the clinic for a visit. He currently has no HIV-related illness.

B20 Human immunodeficiency virus (HIV) disease

Pregnant patients with HIV/AIDS will have a code from chapter 15 as the first-listed code. According to the guideline (I.C.a.2.g), during pregnancy, childbirth, or the puerperium, a patient admitted or presenting for a health care encounter because of an HIV-related illness or asymptomatic HIV should receive a firs-listed code from subcategory O98.7-, Human immunodeficiency (HIV) disease complicating pregnancy, childbirth, and the puerperium, followed by either code B20 and the code(s) for the HIV-related illness or code Z21.

EXAMPLE:

A pregnant patient in her second trimester at 17 weeks presents for a check up. She is HIV positive.

O98.712 Human immunodeficiency virus (HIV) disease complicating pregnancy, second trimester

Z21 Asymptomatic human immunodeficiency virus (HIV) infection status

Z3A.17 17 weeks gestation of pregnancy

The final guideline that will be discussed relates to patient testing. What happens if a patient has been tested for HIV and is coming in for test results and they are negative? The guidelines (I.C.a.2.h.) states when a patient returns to be informed of his/her test results and the test result is negative, code Z71.7, Human immunodeficiency virus (HIV) counseling, should be assigned.

In the next issue, another condition with its related chapter specific ICD-10-CM guidelines will be discussed.

IN THE NEWS

CMS Online ICD-10 Guide
An online ICD-10 Guide, a web-based tool that provides step-by-step guidance on how to transition to ICD-10 for small practices, large practices, small hospitals, and payers, is available from CMS. The information can be broken down by small, medium, or large provider, small hospital, or payer.

CODING SNAPSHOT

A patient presents to the infectious disease clinic for a consultation. She states that she recently found out that her boyfriend has AIDS. She is currently showing no signs/symptoms of an HIV-related illness, but is very concerned about having contracted the virus. She states that she and her boyfriend have had unprotected sex. The rest of her history is negative.

CONSTITUTIONAL: Patient anxious. VSS. HEENT: Unremarkable. Her fundi are benign. NECK: Supple. LUNGS: Clear to auscultation and percussion. CARDIAC: Reveals regular rate and rhythm without murmur, rub or gallop. ABDOMEN: Soft and nontender without organomegaly or mass. EXTREMITIES: Show no cyanosis, clubbing or edema.

Impression: HIV screening after unprotected sexual contact with partner with AIDS.

ICD-10-CM Codes:
Z11.4 Encounter for screening for human immunodeficiency virus (HIV)
Z20.6 Contact with and (suspected) exposure to human immunodeficiency virus (HIV)

Rationale: This patient is presenting with no symptoms, but exposure to AIDS from her boyfriend. As many codes regarding HIV/AIDS as are necessary may be assigned.

ICD-10 IMPLEMENTATION STRATEGIES

We will be sharing a number of strategies to help your practice successfully implement ICD-10-CM. Please remember to track your progress in your ICD-10 Implementation Tracker on AAPC's website.

Keeping Up Interest
Now that we are less than a year away from implementation of ICD-10-CM, it is important to keep interest up among employees regarding the new code set. Make sure to bring up the office, clinic, or facilities progress towards ICD-10 at staff meetings, or discuss upcoming trainings.

ICD-10 is a "use it or lose it" kind of thing. For staff members that have had code set training, get them together once a month/quarter to code some cases in ICD-10 to keep everything fresh. For physicians and other providers, once readiness assessments have been under way for a while, go back to some of the first diagnoses that were reviewed with them to make sure that their documentation is still where it needs to be for ICD-10. Little things can help keep everyone's eye on the coming of ICD-10.

FEATURED RESOURCE

Major Depressive Disorder Reference Guide
Fracture Classification Quick Reference GuideAAPC has added a new resource to the ICD-10-CM Reference Guides. AAPC has created these coding resources to help you make the transition to the new system. These complimentary sheets can be downloaded and make great desk references for your specialty practice. The new one is for major depressive disorders for ICD-10-CM and is a three page document that breaks down the disorders according to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5).

ICD-10 Tips and Resources is offered as a benefit to AAPC members and we hope you find the information useful. If you'd rather not receive future issues of ICD-10 Tips and Resources, please log in to your account and change your email preferences.

AAPC
2233 S Presidents Dr. | Salt Lake City, Utah 84120 | (801) 236-2200

Copyright © 2013 AAPC - All rights reserved.
CPC®, CPC-H®, CPC-P®, CPB, CIRCC®, CPMA®, CPCO, and CPPM® are registered trademarks of AAPC.

CPT copyright 2012 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse or interpretation of information contained in this product.