HIV and Infectious Disease Coding Review
Patricia Maccariella, RRA, CCS
The coding of HIV and related cases have specific rules to be followed. There are references to HIV coding contained within the Coding Clinic. Specifically, the issues pertinent are listed under “Human Im-munodeficiency Virus (HIV).” Be sure to review all of the Coding Clinics pertinent to HIV coding before the tests. The guidelines for HIV coding are contained in section 10 of The Official ICD-9-CM Guidelines for Coding and Reporting. They are listed in Coding Clinic, 1994 4Q pp. 29-36. We will review these specific guidelines shortly.
For now, take the following short quiz without reviewing the guidelines. See how many you can answer correctly from your memory. The guidelines after the quiz will help in your review.
1. A one-month-old infant has tested positive for HIV on a test done this admission. The attending physician has documented the newborn as having HIV infection. Guidance in the Coding Clinic has stated that newborns can test false-positive results during the first 18 months of life. What is the proper code(s) for this scenario?
a) V08, Asymptomatic HIV infection status
b) 042 HIV disease
c) 795.71 Nonspecific serologic evidence of HIV
2. An emergency room nurse receives a needle stick on the fingertip from a needle used by a patient with known HIV disease. What is the correct code(s)?
a) V08 Asymptomatic HIV infection status
b) V01.7, Contact with or exposure to HIV, E920.5, Hypodermic needle (accident caused by)
c) 883.0, Open wound of finger, V01.7, E920.5
3. A patient is admitted with acute pyelone-phritis. The patient had been treated one year ago for AIDS-related candidal infections of the mouth. There is no reference that the acute pyelonephritis is related to or due to the patient’s AIDS. What are the diagnoses, principal first?
a) 042, AIDS, 590.10, acute pyelonephritis
b) 590.10, acute pyelonephritis, 042 AIDS
c) 042, AIDS, 590.10, acute pyelonephritis, 112.0, Candidiasis of mouth.
4. A patient visits his physician’s office for elective HIV testing. The patient admits to high-risk behavior in the past that could have exposed him to HIV. He has never been tested before. The results of this test will be available in a couple weeks. What is the correct coding?
a) V72.6, Laboratory exam, V69.8, Other problems related to lifestyle
b) V69.8, Other problems related to lifestyle
c) V01.7, Contact or exposure to HIV, V69.8, Other problems related to lifestyle.
5. The same patient in question #4 above returns to the office two weeks later. The physician reports that the results are negative. The physician provides education and advice on HIV and its prevention.
a) V72.6, Laboratory exam, V69.8, Other problems related to lifestyle.
b) V65.44, HIV counseling
c) V72.6, Laboratory exam, V65.44, HIV Counseling
6. A patient receives HIV counseling as an outpatient, but will not submit to an HIV test. She is a suspected carrier of HIV. What codes are assigned?
a) V65.44, HIV counseling, 042, HIV disease
b) V01.7, Exposure to HIV, V65.44, HIV counseling, V02.9, Suspected carrier of HIV
c) V65.44, HIV counseling, V02.9, Sus-pected carrier of HIV.
The following are the coding guidelines for HIV coding.
10.1 Code only confirmed cases of HIV infection/illness
This rule is an exception to the official 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.” In this context, “confirmation” does not require documentation of positive serology or culture for HIV; the physician’s diagnostic statement that the patient is HIV positive or has an HIV-related illness is sufficient.
10.2 Selection of HIV Code
042 Patients with an HIV related illness should be coded to 042, Human Immu-nodeficiency Virus [HIV] Disease.
V08 Patients with physician-documented asymptomatic HIV infections who have never had an HIV-related illness should be coded to V08, Asymptomatic Human Immunodeficiency Virus [HIV] infection.
795.71 Code 795.71, Nonspecific serologic evidence of human immunodeficiency virus [HIV], should be used for patients (including infants) with inconclusive HIV test results.
V01.7 Patients with exposure to HIV should be assigned code V01.7, Contact with or exposure to other viral communicable diseases. See Coding Clinic 1994 4Q p. 29-36.
10.3 Previously diagnosed
Patients with any known prior diagnosis of an HIV-related illness should be coded to 042. Once a patient has developed an HIV-related illness, the patient should always be assigned code 042 on every subsequent admission. Patients previously diagnosed with any HIV illness (042) should never be assigned to 795.71 or V08.
The sequencing of diagnoses for patients with HIV-related illnesses follows official guideline 2 for selection of principal diagnosis for inpatients. That is, the circumstances of admission govern the selection of principal diagnosis, “that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.”
Patients who are admitted for an HIV-related illness should be assigned a minimum of two codes: first assign code 042 as principal to identify the HIV disease and then sequence secondarily, additional codes to identify the other diagnoses.
If a patient with HIV disease is admitted for an unrelated condition (such as a traumatic injury), the code for the unrelated condition (e.g., the nature of injury code) should be the principal diagnosis. Other diagnoses would be 042 followed by additional diagnosis codes for all reported HIV-related conditions.
Whether the patient is newly diagnosed or has had previous admissions for HIV conditions (or has expired) is irrelevant to the sequencing decision.
10.5 HIV Infection in Pregnancy, Childbirth and the Puerperium
During pregnancy, an obstetric patient admitted because of an HIV-related illness should receive a principal diagnosis of 647.6X, Other specified infectious and parasitic diseases in the mother classifiable elsewhere, but complicating the pregnancy, childbirth or puerperium, other viral diseases followed by 042 and the code(s) for the HIV-related illness (es). This is an exception to the sequencing rule found in 10.4 above.
Patients with asymptomatic HIV infection status admitted during pregnancy, childbirth, or the puerperium should receive codes of 647.6X and V08.
10.6 Asymptomatic HIV infection
V08, Asymptomatic HIV infection is to be applied when the patient without any documentation of symptoms is listed as being “HIV positive,” “known HIV,” “HIV test positive,” or similar terminology. Do not use this code if the term “AIDS” is used or if the patient is treated for any HIV-related illness or is described as having any condition(s) resulting from his/her HIV positive status; use 042 in these cases.
10.7 Inconclusive Laboratory Test for HIV
Patients with inconclusive HIV serology, but not definitive diagnosis or manifestations of the illness may be assigned code 795.71, Inconclusive serologic test for Human Immunodeficiency Virus (HIV).
10.8 Testing for HIV
If the patient is asymptomatic but wishes to know his/her HIV status use code V73.89, Screening for other specified viral disease. Use code V69.8, Other problems related to lifestyle, as a secondary code if an asymptomatic patient is in a known high-risk group for HIV. Should a patient with signs or symptoms or illness, or a confirmed HIV-related diagnosis be tested for HIV, code the signs and symptoms or the diagnosis. An additional counseling code V65.44, HIV counseling, may be used if counseling is provided during the encounter for the test.
When the patient returns to be informed of his/her HIV test results, use code V65.44, HIV counseling, if the results of the test are negative. If the results are positive but the patient is asymptomatic, use code V08, Asymptomatic HIV infection. If the results are positive and the patient is symptomatic, use code 042, HIV infection, with codes for the HIV related symptoms or diagnosis. The HIV counseling code may also be used if counseling is provided for patients with positive test results.
The above official guidelines for coding cover just about every situation encountered in HIV coding. In addition Coding Clinic has many references to the coding of HIV, and it is a good idea to review each one. See the Coding Clinic index or a study guide for a list of all the relevant issues containing HIV and other infectious disease entries. You may want to write yourself reminder notes within your codebooks.
Patricia Maccariella is manager of coding review services at United Audit Systems Inc. (UASI), headquartered in Cincinnati.
ANSWERS: 1. b (042) See guideline 10.1. Physician has made diagnosis; 2. c (883.0, V01.7, E920.5) See guideline 10.8; 3. b (590.10, 042) See guideline 10.4 and Coding Clinic 4Q 1994; 4. a (V72.6, V69.8) See guideline 10.8. Also, patient was never exposed to others with confirmed HIV. V01.7 would not apply; 5. b (V65.44) The patient received counseling only. No mention of the high-risk behavior in this record so cannot assign V69.8; 6. c (V65.44, V02.9) See Coding Clinic, 4Q 1994, p. 36.