Spring has finally arrived across most of the country. The landscape is taking on the colors of blooming flowers and trees. This time of year signals new opportunities so let’s revisit one of the diagnoses that can be confusing to coders - HIV and AIDS. We will endeavor to better understand the disease process and requirements for documentation. In turn, as coders, we will be better prepared to analyze record documentation, assign accurate code and identify when a query is needed. Human Immunodeficiency Virus (HIV), is a retrovirus that destroys the immune system, disabling the body’s ability to fight infections causing some lymphomas, other malignancies, and opportunistic infections to grow. The Official Coding Guidelines that we followed for coding HIV/ Acquired Immune Deficiency Syndrome (AIDS) in ICD-9-CM have not changed for ICD-10-CM. The only difference is that the codes have changed:
Regardless of whether a patient is newly diagnosed or has had previous admissions/encounters for HIV conditions, is irrelevant to the sequencing decisions.
This is an exception to the rule on the Inpatient side!
HIV Positive: Code Z21 Used when the patient has never been diagnosed with AIDS or an AIDS-defining condition. Also called “asymptomatic HIV” in ICD-10-CM.
Diagnostic Criteria For adults, adolescents, and children >18 months of age, the CDC defines AIDS as an HIV-positive patient with any one of the following:
OR
Coding for HIV For inpatient coding, the physician must state the diagnosis, and if not clearly documented, there is an opportunity to query for clarification. For outpatient coding, it is often challenging for coders to determine if the patient is just HIV + (Z21) or if the patient has ever had an HIV-related illness (B20). As of now, most outpatient coders do not have the capability to query for OP coding. If the coder is unable to determine which the patient has based on the documentation provided, we should default to asymptomatic, rather than assigning the patient a diagnosis of AIDS. Opportunistic Infections (OIs) Healthy immune systems can be exposed to certain viruses, bacteria, or parasites and have no reaction to them. However, people living with HIV/AIDS may have serious health threats from what are known as “opportunistic infections (OIs)”. These infections attack the weakened immune system and can be life-threatening. OIs are signs of a declining immune system. Most life-threatening OIs occur when the CD4 count falls below 200 cells/mm3. The CDC developed a list of more than 20 OIs that are considered AIDS-defining conditions. Patients having laboratory-confirmed HIV infections and one or more of these OIs, will be diagnosed with AIDS regardless of the CD4 count.  AIDS is the final stage of human immunodeficiency virus (HIV) infection, stage 4 by the World Health Organization (WHO) criteria (2007) and stage 3 by Centers for Disease Control and Prevention (CDC) (2008) criteria or clinical categories B or C (CDC). AIDS code (B20) applies if AIDS has ever been previously diagnosed. B20 must always be coded on every single subsequent encounter and never again code Z21 once AIDS is assigned.
Major AIDS-Related Conditions Therapeutic Treatment
-Zidovudine (Retrovir, ZDZ,AZT) and Lamivudine (Epivir, 3TC) = Combivir -Lamivudine (Epivir, 3TC) and Stavudine (Zerit, d4T) -Didanosine (Videx, Videx EC, ddl) and Stavudine (Zerit,d4T)
A lot of information is included that I trust will clarify the assignment of HIV and AIDS as well as opportunities for the query. Take time to enjoy the Spring! REFERENCES
About the Author Marie Thomas holds a Masters in Healthcare Administration from Pfeiffer University, Charlotte, NC, and a Bachelor of Science in Healthcare Administration from Pfeiffer University. Marie has furthered her career education by becoming an AHIMA-Approved ICD-10-CM/PCS Trainer and Ambassador as well as earning the RHIT, CCS, CCDS, and CPC-H credentials. For more information please comment below.
Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. In most cases the manifestation codes will have in the code title, "in diseases classified elsewhere." Codes with this title are a component of the etiology/manifestation convention. The code title indicates that it is a manifestation code. "In diseases classified elsewhere" codes are never permitted to be used as first listed or principle diagnosis codes. They must be used in conjunction with an underlying condition code and they must be listed following the underlying condition.
Code First Code First Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. In most cases the manifestation codes will have in the code title, "in diseases classified elsewhere." Codes with this title are a component of the etiology/manifestation convention. The code title indicates that it is a manifestation code. "In diseases classified elsewhere" codes are never permitted to be used as first listed or principle diagnosis codes. They must be used in conjunction with an underlying condition code and they must be listed following the underlying condition.
Type 1 Excludes Type 1 Excludes Help A type 1 excludes note is a pure excludes. It means "not coded here". A type 1 excludes note indicates that the code excluded should never be used at the same time as B20. A type 1 excludes note is for used for when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
Includes Includes Help "Includes" further defines, or give examples of, the content of the code or category.
The following code(s) above B20 contain annotation back-references Annotation Back-References In this context, annotation back-references refer to codes that contain:
Convert B20 to ICD-9-CM Code History
Code annotations containing back-references to B20:
Diagnosis Index entries containing back-references to B20:
ICD-10-CM Codes Adjacent To B20
B18.9 Chronic viral hepatitis, unspecified B19 Unspecified viral hepatitis B19.0 Unspecified viral hepatitis with hepatic coma B19.1 Unspecified viral hepatitis B B19.10 …… without hepatic coma B19.11 …… with hepatic coma B19.2 Unspecified viral hepatitis C B19.20 …… without hepatic coma B19.21 …… with hepatic coma B19.9 Unspecified viral hepatitis without hepatic coma B20 Human immunodeficiency virus [HIV] disease B25 Cytomegaloviral disease B25.0 Cytomegaloviral pneumonitis B25.1 Cytomegaloviral hepatitis B25.2 Cytomegaloviral pancreatitis B25.8 Other cytomegaloviral diseases B25.9 Cytomegaloviral disease, unspecified B26.0 Mumps orchitis B26.1 Mumps meningitis B26.2 Mumps encephalitis Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes. |
What is the correct code to indicate HIV patient WHO has never been treated for an HIV-related condition?
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