HIV coding in California

renmeyer@sbcglobal.netrenmeyer@sbcglobal.net
in Clinical & Coding

Good morning

It is my understanding from our coding department that HIV does not get coded in California.  Is this correct?

Thank You.

Renee

Comments

  • jmccorkl@stanfordhealthcare.orgjmccorkl@stanfordhealthcare.org
    I have never heard that.  We are in the SF Bay Area and code HIV status and HIV disease as appropriate.  
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    California as a quirk in that OSHPD dictates that 'only' confirmed cases of AIDS are coded.    HIV infected patients that do not meet criteria for AIDS are not assigned a code.  (There are different codes for HIV+  VERSUS  AIDS.  If you need to know more, suggest you visit the OSHPD website for detailed instructions. 
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org

    Physician/PA/NP (Check Any that Apply)

     

        Asymptomatic HIV Status without any history of (or current) AIDS-Defining Illness or HIV-Related      Illness

     

        AIDS: Meets the current CDC Definition of AIDS - HIV-infected persons who have less than 200 CD4+ T-lymphocytes/uL, or CD4+ T-lymphocyte percentage of total lymphocytes of less than 14, and/or an AIDS-Defining Illness or HIV-Related Disease. See the reverse side for examples.

     

    Per CDC publication Vol 60 RR-17 http://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm

    Relating to the classification HIV Infection, once a patient is diagnosed with AIDS the diagnosis still stands even if, after treatment, the CD4+ T cell count rises to above 200 per µL of blood or other AIDS-defining illnesses are cured.

  • rpinson@hcq1.comrpinson@hcq1.com
    Renee: This issue of HIV+ reporting appears to be somewhat confusing and controversial. There seem to be opinions on both sides of the question.  In general, the California Health and Safety Code (CHSC) Sections 120975 and 120980 prohibit the disclosure of any HIV test results whether positive, negative, or inconclusive without the patient’s written authorization for each disclosure but there are provisions for several exceptions (see the summary of California HIV/AIDS Laws 2009 from the California Department of Public Health - January 2010 available at: https://archive.cdph.ca.gov/programs/aids/Documents/RPT2010_01HIVAIDSLaws2009.pdf ).

    One of the exceptions that allows disclosure of an individual’s HIV test results without prior authorization is to the "test subject’s provider of health care (Civil Code Section 56.05) but not a health care service plan....".  To my mind this appears to prohibit submission of an HIV test result code to a health plan but I cannot offer you or anyone else legal advice. ICD-10 test result codes include:
    • Z21 - HIV test positive only (HIV infection) without AIDS (HIV disease)
    • R75 - inconclusive HIV test result
    As best as I can determine, the statutes may apply only to test results and perhaps not to the clinical diagnosis of AIDS/HIV disease. (ICD-10 code B20).

    CHSC Code Section 121022(a) requires health care providers and clinical laboratories to report HIV infection by patient name to the local public health officer.

    I believe that any definitive answer to your question must come from a California attorney familiar with the State's statues and regulations applicable to reporting and disclosure of HIV and AIDS.

    As a clarification, I'd like to point out that California's Office of Statewide Health Planning and Development (OSHPD) collects data and disseminates information about California's healthcare infrastructure.  It does not govern the reporting or disclosure of HIV test results.  Since it is not a public health agency, reporting of HIV test results to it is prohibited and OSHPD employs warning edits for HIV test result codes to prevent inadvertent reporting in data sent to OSHPD. 

    Richard D. Pinson, MD, FACP, CCS
    Pinson & Tang
    CDI Educators and Advisers
    Authors of the CDI Pocket Guide
    www.pinsonandtang.com




  • jmccorkl@stanfordhealthcare.orgjmccorkl@stanfordhealthcare.org
    jmccorkl@stanfordhealthcare.org said:
    I have never heard that.  We are in the SF Bay Area and code HIV status and HIV disease as appropriate.  
    I was mistaken - I followed up with our Coding Manager and indeed only B20 HIV Disease/AIDS is coded, not Z21 Asymptomatic HIV + status.  I learned something!  : )
  • djones32djones32

    I would like to follow up on this question. I live in California. I have several CDI friends at different hospitals. Some say we aren't allowed to code B20, my Coding supervisor says we can. I'm trying to find out how to confirm this. Is different hospital to hospital? Then I saw some info that OSHPD removes B20? It's confusing to me and I'm getting many different answers. Thank you

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