State & FederalMedicaidMarch 31, 2020

Coding spotlight: HIV and AIDS

Code only confirmed cases
According to ICD-10-CM coding guidelines for Chapter One, code only confirmed cases of HIV infection/illness. This is an exception to the hospital inpatient guideline Section II, H. 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.

Status

ICD-10-CM code

Asymptomatic HIV

 
  • Assign code Z21 — Asymptomatic human immunodeficiency virus [HIV] infection status when the patient without any documentation of symptoms is listed as being ‘HIV positive’, ‘known HIV’, ‘HIV test positive’ or similar terminology.
  • Assign code B20 — Human immunodeficiency virus [HIV] disease on the claim when the term AIDS is used, when the patient is being treated for HIV-related illness or when the patient is described as having any active HIV-related condition.

Patients with inconclusive HIV serology
  • Assign code R75 — Inconclusive laboratory evidence of human immunodeficiency virus [HIV] when the patient’s record is documented with inconclusive HIV serology, but there is no definitive diagnosis or manifestations of the illness.

Previously diagnosed HIV-related illness
  • Code B20 if you document a patient as having had any known prior diagnosis of an HIV-related illness — Z21 is no longer reported. If the patient develops an HIV-related illness, they should be assigned code B20 on every subsequent admission/encounter.

HIV infection in pregnancy, childbirth and the puerperium

 
  • Assign code O98.7 — Human immunodeficiency virus [HIV] disease complicating pregnancy, childbirth and the puerperium first when a patient presents for treatment of an HIV-related illness during pregnancy, childbirth or the puerperium followed by code B20.
  • Also assign additional code(s) for HIV-related illness(es). Keep in mind that codes from Chapter 16 take priority when sequencing codes on the claim.
  • If a patient with asymptomatic HIV infection status presents for a routine visit during pregnancy, childbirth or the puerperium, the correct code assignment would be O98.7 followed by code Z21.

Assign code B20 for all types of HIV infections, which may be described by a variety of terms including:

  • AIDS.
  • Acquired immune deficiency syndrome.
  • Acquired immunodeficiency syndrome.
  • AIDS-related complex (ARC).
  • AIDS-related conditions.
  • HIV infection, symptomatic.

 

Testing for HIV:

  • Assign code Z11.4 — Encounter for screening for human immunodeficiency virus [HIV] when seeing a patient with no prior diagnosis of HIV infection or positive HIV-status to determine their HIV status.
  • Code the signs and symptoms when seeing a patient with signs or symptoms for HIV testing. If you provide counseling during the encounter, assign additional code Z71.7 — Human immunodeficiency virus [HIV] counseling.
  • Assign code Z71.7 if a patient’s test results are negative for HIV.
  • Assign code Z72.8 if a patient is known to be in a high-risk group for HIV infection. Other problems related to lifestyle can be assigned as an additional code.

Major HIV-related conditions

 

HIV-related condition

ICD-10-CM code

Pneumonia, unspecified organism

J18.9

Tuberculosis of other sites

A18.89

Sepsis, unspecified organism

A41.9

Candida stomatitis (thrush)

B37.0

Herpes zoster (any site)

B02.9

Encephalopathy, unspecified

G93.40

Other HIV-related conditions

 

Tinea cruris

B35.6

Anemia, unspecified

D64.9

Underweight

R63.6

Acute lymphadenitis

L04.9

Arthropathy, unspecified

M12.9

Splenomegaly, not elsewhere classified

R16.1

Weakness

R53.1

HIV/AIDS prevention

The CDC works with other federal agencies, state and local health departments, national organizations, and other entities to reduce the spread of HIV in the United States. This work covers several components:

  • Behavioral interventions — These interventions ensure people have the information, motivation and skills necessary to reduce the risk of infection.
  • HIV testing — Testing is critical to prevent the spread of HIV.
  • Treatment and care — Treatment and care enable individuals with HIV to live longer, healthier lives.

 

The CDC remains on the forefront of pursuing high-impact prevention. This approach is designed to maximize the impact of prevention efforts for all Americans at risk for HIV infections and the CDC is aligning its efforts with the first National HIV/AIDS Strategy for the United States (NHAS). The Division of HIV/AIDS Prevention has developed a strategic three-year plan for 2017 to 2020 with the goal of one day achieving a future free of HIV.

 

Resources:

  1. ICD-10-CM Expert for Physicians. The complete official code set. Optum360, LLC. 2019.
  2. http://www.cdc.gov: HIV/AIDS.


ANV-NU-0105-19 February 2020

PUBLICATIONS: April 2020 Anthem Provider News and Important Updates -- Nevada