HIV Disease

mannb1mannb1
in CDI Talk Archive
Hello, all,
I am hoping to hear from CDS and coders alike on this one. I had a patient admitted w/alcoholic gastritis causing pancreatitis = MCC. Per PN pt is HIV - on outpt Rx (Atripla) & reports he follows up w/county health dept for infectious dz. CD4 count was done, as not done "in a while". CD$ count low @ 5. As CDS, I queried MD for HIV status: 1)HIV disease 2) HIV/AIDS 3)HIV + only 4)other/unable to determine? MD responded to query with "HIV disease" 2 times in the progress notes. My coders will not code as 042. In this case, it does NOT change DRG, SOI/ROM - DRG> 391 w/MCC of pancreatitis.
Any thoughts on why HIV disease - 042 cannot/should not be coded? Any references on this to help my case? Or am I just mistaken?

thanks,
Becky Mann, RN, CDS
Sutter Solano Medical Center

Comments

  • catladyrncatladyrn
    I am not a coder, but it appears to me that you have an HIV-positive patient without evidence of AIDS. "HIV disease" in the absence of previous or current documentation of AIDS or symptomatic disease is not specific enough to warrant the 042 code, but only V08. I see no evidence in what you've charted of any HIV-related illness, only prophylactic treatment.

    I could be wrong, of course.

    Renee


    Linda Renee Brown, RN, CCRN, CCDS
    Certified Clinical Documentation Specialist
    Banner Good Samaritan Medical Center
  • paxnerospaxneros
    edited May 2016
    HIV is very complicated sometimes.

    Question:

    - has the patient ever been diagnosed with an HIV -related illness?

    Usually the patient must be admitted with or has been treated in the past or currently w/ an HIV-related disease (Kaposi's Sarcoma, PCP, etc.) Or the physician must state that the diagnosis the patient
    is being admitted for is due to the patients HIV, to receive 042. Otherwise it is coded to V08.

    In this case the gastritis is not caused by the patients HIV. Unless the patient has had a documented HIV related disease this person will be assigned V08.

    If your physician has written AIDS then 042 may be coded. AIDS defines a person who is HIV (+) and has been diagnosed at some time with an AIDS related illness.

  • jolene.filejolene.file
    Hi Becky-
  • johnsok5johnsok5
    This comes from Faye Brown's Coding Handbook
    Coding of Infectious and Parasitic Diseases, Endocrine Diseases and Immunity Disorders, and Mental Disorders
    10 Infectious and Parasitic Diseases
    AIDS AND OTHER HIV INFECTIONS
  • mary.a.dunnmary.a.dunn
    edited May 2016
    Jolene,
    You attached a coding clinic for HIV but it didn't come through. Could you send it again?
    Thanks
    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, July 21, 2011 4:09 PM
    To: Mary A. Dunn
    Subject: RE: [cdi_talk] HIV Disease

    Hi Becky-

    Check out the ICD-9-CM Official Coding Guidelines for Coding & Reporting - Effective 10/1/2010.......page 13 -Chapter Specific Coding Guidelines a) Human Immunodeficiency Virus (HIV) infections. This should help you decide if it should be coded. (f) Patients with any known prior diagnosis of an HIV-related illness should be coded to 042.

    PS. You can usually find a copy in the front of most coding books, or if you have 3M in the C.Clinic reference section.

    Hope that is helpful.

    Jolene File, RHIT,CCS,CPC-H,CCDS
    Documentation Improvement Specialist-Coder

    IMPORTANT: This communication contains information from Hays Medical Center which may be confidential and privileged. If it appears that the communication was addressed or sent to you in error, you may not use or copy this communication or any information contained therein, and you may not disclose this communication or the information contained therein to anyone else. In such circumstances, please notify me immediately by reply email or by telephone. Thank you.




  • lspryszaklspryszak
    edited May 2016
    Did you know that there are not separate codes for HIV versus AIDS? There is only one code - 042 - which will either be the PDx or the SDx, depending on the circumstances of admission and the following rules. Also once the 042 code has been assigned to a patient record it is coded on all subsequent encounters.

    I would encourage everyone to read the diagnoses listed under DRGs 974 and 977 in the DRG Expert. The conditions listed here, combined with the 042 code will identify a patient as having HIV. You will note that many of the diagnoses are not what we would think of as HIV or AIDS diagnoses -- unspecified pneumonia (486), for example or volume depletion (276.5x). Nevertheless, once one of these diagnoses is reported with 042 (HIV), the patient is no longer just HIV+, they now have HIV (symptomatic) and will be from this point forward.

    From the 2011 Official Coding Guidelines:

    Chapter 1: Infectious and Parasitic Diseases (001-139)

    a. Human Immunodeficiency Virus (HIV) Infections

    1) Code only confirmed cases
    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.

    2) Selection and sequencing of HIV codes

    (a) Patient admitted for HIV-related condition
    If a patient is admitted for an HIV-related condition, the principal diagnosis should be 042, followed by additional diagnosis codes for all reported HIV-related conditions.

    (b) Patient with HIV disease admitted for unrelated condition
    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.

    c) Whether the patient is newly diagnosed
    Whether the patient is newly diagnosed or has had previous admissions/encounters for HIV conditions is irrelevant to the sequencing decision.

    (d) Asymptomatic human immunodeficiency virus

    V08 Asymptomatic human immunodeficiency virus [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.

    (e) Patients with inconclusive HIV serology
    Patients with inconclusive HIV serology, but no definitive diagnosis or manifestations of the illness, may be assigned code 795.71, Inconclusive serologic test for Human Immunodeficiency Virus [HIV].

    (f) Previously diagnosed HIV-related illness
    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/encounter. Patients previously diagnosed with any HIV illness (042) should never be assigned to 795.71 or V08.

    (g) HIV Infection in Pregnancy, Childbirth and the Puerperium
    During pregnancy, childbirth or the puerperium, a patient admitted (or presenting for a health care encounter) because of an HIV-related illness should receive a principal diagnosis code of 647.6X, Other specified infectious and parasitic diseases in the mother
    classifiable elsewhere, but complicating the pregnancy, childbirth or the puerperium, followed by 042 and the code(s) for the HIV-related illness(es). Codes from Chapter 15 always take sequencing priority.

    Patients with asymptomatic HIV infection status admitted (or presenting for a health care encounter) during pregnancy, childbirth, or the puerperium should receive codes of 647.6X and V08.
  • digardskdigardsk
    edited May 2016
    I know California has some specific rules regarding HIV / AIDs coding. I usually confer with our coders when we get a case that is not clear to make sure I stay on track. Anyone else from California that can clarify for Becky?

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Regarding HIV Disease, this is coded as 042. The statement HIV+ is NOT coded as 042.

    The basis is the OFFICIAL GUIDELINES FOR ICD, WHICH STATE:


    These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-9-CM itself. The instructions and conventions of the classification take precedence over guidelines. These guidelines are based on the coding and sequencing instructions in Volumes I, II and III of ICD-9-CM, but provide additional instruction. Adherence to these guidelines when assigning ICD-9-CM diagnosis and procedure codes is required under the Health Insurance Portability and Accountability Act (HIPAA).


    With this statement in mind, these guidelines lead directly to 042 for HIV DISEASE.

    The statement HIV Disease in the Index to Diseases states: “Disease HIV” = 042. The Tabular List also states: HIV Disease, 042.



    However, the statement “HIV+” is not coded as 042 – these terms do not indicate any symptoms or manifestations as a consequence of the HIV status and, alone, would not justify a code for 042.
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