Coding Guidelines for AIDS, HIV Infection

To assign ICD-9-CM diagnosis codes appropriately for AIDS and HIV-related conditions, the coder must keep in mind several extremely important coding guidelines. First, the coding of AIDS involves an exception to coding guideline 1.8, which states: “If the diagnosis documented at the time of discharge is qualified as ‘probable,’ ‘suspected,’ ‘likely,’ ‘questionable,’ ‘possible’ or ‘still to be ruled out,’ code the condition as if it existed or was established.” A diagnosis of AIDS must be confirmed and substantiated by a physician in the medical record before a final diagnosis code of AIDS, 042 [Human Immunodeficiency Virus [HIV] Disease], is assigned. Not only is this important from the standpoint of public health statistics and not labeling a patient with a condition that does not exist, but it is also vital in terms of ensuring that patients with the disease are able to access various medical assistance programs.

Second, once a patient has developed an HIV-related illness, code 042 should always be assigned for that patient’s record on every subsequent admission. In a sense, this code assignment recognizes that a patient cannot move “backwards” from fully developed AIDS to Asymptomatic Human Immunodeficiency Virus [HIV] Infection [V08] or Nonspecific Serologic Evidence of Human Immunodeficiency Virus [HIV] [795.71].

Understanding Circumstances
Further, it’s important to understand the appropriate circumstances for assigning codes V01.79, V08 and 795.71. If a patient was exposed to HIV and no further information is available, assign code V01.79, Contact with or exposure to other viral diseases. Inconclusive HIV serology with no definitive diagnosis or manifestations of the HIV illness is assigned to code 795.71. If a patient presents to a health care facility for HIV testing and is asymptomatic, code V73.89, Screening for other specified viral disease, should be assigned, along with a secondary code of V69.2, High-risk sexual behavior, if this information is documented for the patient.