Why ICD-10 codes are important
Answer: Following ICD-10 guidelines, a patient with HIV status without symptoms is coded with Z21, positive HIV status. Some doctors and non-physician practitioners would prefer to use B20. According to ICD-10, B20 is used when the patient has confirmed AIDS.
Once a patient is coded to B20, they will always have B20 coded on their record; they will never go back to being coded using the asymptomatic code Z21. Code Z21 is used for patients who are asymptomatic, meaning they are HIV positive but have never had an HIV-related condition.
If a patient is admitted for an HIV-related condition, B20 Human immunodeficiency virus (HIV) disease should be sequenced first, followed by additional diagnosis codes for all reported HIV-related conditions.
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.
Z21 is not usually sufficient justification for admission to an acute care hospital when used a principal diagnosis.
Z71. 7 — Human immunodeficiency virus [HIV] counseling.
Human immunodeficiency virus [HIV] disease B20 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM B20 became effective on October 1, 2021.
The primary ICD 10 code should be HIV B20 and the secondary diagnoses code is HIV related condition.
ICD 10 code for HIV should be coded only when it’s confirmed from the provider
A symptomatic HIV patient is at initial visit for sprained left ankle
ICD 10 code for Encounter for screening is Z11.4
Clinical Information. Development of neutralizing antibodies in individuals who have been exposed to the human immunodeficiency virus (hiv/htlv-iii/lav). Infected with the human immunodeficiency virus (hiv), the cause of acquired immunodeficiency syndrome (aids).
The 2022 edition of ICD-10-CM Z21 became effective on October 1, 2021.
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.
Code Z79.899, Other long term (current) drug therapy, may be assigned as an additional code to identify the long-term (current) use of antiretroviral medications.
Changes to ICD-10-CM coding are effective October 1. The 2022 changes are effective October 1, 2021, even though we call them the 2022 year codes and changes. This year, there is a new guideline for coding HIV/AIDS when the patient is on an anti-retroviral drug. This is from the Official Guidelines.
The 2022 edition of ICD-10-CM O98.7 became effective on October 1, 2021.
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.
Sequencing. The proper sequencing for HIV depends on the reason for the admission or encounter. When a patient is admitted for an HIV-related condition, sequence B20 Human immunodeficiency virus [HIV] disease first, followed by additional diagnosis codes for all reported HIV-related conditions. Conditions always considered HIV-related include ...
In the inpatient setting, HIV is the only condition that must be confirmed to select the code. All other conditions documented as “probable,” suspected,” likely,” “questionable,” “probable,” or “still to rule out” are coded as if they exist in the inpatient setting. Dx. Sequencing. The proper sequencing for HIV depends on the reason for ...
HIV infection/illness is coded as a diagnosis only for confirmed cases. Confirmation does not require documentation of a positive blood test or culture for HIV; the physician’s diagnostic statement that the patient is HIV positive or has an HIV-related illness is sufficient.#N#In the inpatient setting, HIV is the only condition that must be confirmed to select the code. All other conditions documented as “probable,” suspected,” likely,” “questionable,” “probable,” or “still to rule out” are coded as if they exist in the inpatient setting.#N#Dx. Sequencing#N#The proper sequencing for HIV depends on the reason for the admission or encounter. When a patient is admitted for an HIV-related condition, sequence B20 Human immunodeficiency virus [HIV] disease first, followed by additional diagnosis codes for all reported HIV-related conditions. Conditions always considered HIV-related include Kaposi’s sarcoma, lymphoma, Pneumocystis carinii pneumonia (PCP), cryptococcal meningitis, and cytomegaloviral disease. These conditions are considered opportunistic infections.#N#If a patient with HIV disease is admitted for an unrelated condition (e.g., fracture), sequence the code for the unrelated condition, first. Report B20 as an additional diagnosis, along with any HIV-related conditions.#N#Apply Z21 Asymptomatic human immunodeficiency virus [HIV] infection status when the patient is HIV positive and does not have any documented symptoms of an HIV-related illness. Do not use this code if the term AIDS is used. If the patient is treated for any HIV-related illness, or is described as having any condition resulting from HIV positive status, use B20.#N#Patients with inconclusive HIV serology, and no definitive diagnosis or manifestations of the illness, may be assigned code R75 Inconclusive laboratory evidence of human immunodeficiency virus [HIV].#N#Known prior diagnosis of an HIV-related illness should be coded to B20. After a patient has developed an HIV-related illness, the patient’s condition should be assigned code B20 on every subsequent admission/encounter. Never assign R75 or Z21 to a patient with an earlier diagnosis of AIDS or symptomatic HIV (B20).#N#If a patient is being seen to determine HIV status, use code Z11.4 Encounter for screening for human immunodeficiency virus [HIV]. Should a patient with signs, symptoms or illness, or a confirmed HIV-related diagnosis be tested for HIV, code the signs and symptoms or the diagnosis. If the results are positive and the patient is symptomatic, report B20 with codes for the HIV-related symptoms or diagnosis. The HIV counseling code (Z71.7) may be used if counseling is provided for patients with positive test results. When a patient believes that he/she has been exposed to or has come into contact with the HIV virus, report Z20.6.