CONTINUUM: Lifelong Learning in Neurology:
doi: 10.1212/01.CON.0000423856.85819.04
Practice Issues

Coding for HIV Infections

Powers, Laura B. MD, FAAN

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Address correspondence to AAN Medical Economics and Management Committee, c/o Luana Ciccarelli, Senior Medical Economics Administrator, 201 Chicago Ave, Minneapolis, MN 55415, lciccarelli@aan.com.

Relationship Disclosure: Dr Powers serves as ICD-9-CM advisor for the Coding Subcommittee of the AAN Medical Economics and Management Committee and serves in an editorial capacity for Neurology: Clinical Practice.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Powers reports no disclosure.

Accurate coding is an important function of neurologic practice. This section of CONTINUUM is part of an ongoing series that presents helpful coding information along with examples related to the issue topic. Tips for diagnosis coding, evaluation and management coding, procedure coding, or a combination are presented, depending on which are most useful for the subject area of the issue.

Infectious disease diagnoses, and especially HIV, lend themselves well to a discussion of sequencing codes in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). In both classifications the convention is to sequence the code for etiology first and for manifestation second unless the manifestation is a sequela (or “late effect”) of the etiology. In the case of sequelae, the manifestation is listed first. In a few epidemiologic circumstances, this ordering of diagnoses might change, most notably in the settings of HIV and pregnancy. This emphasis on sequencing is a result of the fact that both ICD-9-CM and ICD-10-CM are primarily classifications for morbidity and mortality reporting, even though they are tied to the reimbursement process in the United States.

The Official Guidelines for Coding and Reporting for ICD-9-CM1 give specific sequencing instructions for coding any diagnoses in a patient with HIV. The guideline is similar for ICD-10-CM.2 (The implementation date for ICD-10-CM is under reconsideration at time of writing this article.) The diagnosis HIV is always listed first, unless the patient is also pregnant or the condition for which the patient is being evaluated or treated is not related to the HIV infection. There is only one code for HIV (HIV-1) infection in the ICD-9-CM:

042 Human immunodeficiency virus (HIV) disease

 Acquired immune deficiency syndrome

 Acquired immunodeficiency syndrome

 AIDS

 AIDS-like syndrome

 AIDS-related complex

 ARC

 HIV infection, symptomatic

Use additional code(s) to identify all manifestations of HIV

Use additional code to identify HIV-2 infection (079.53)

Excludes: Asymptomatic HIV infection status (V08)

 Exposure to HIV virus (V01.79)

 Nonspecific serologic evidence of HIV (795.71)

The ICD-10-CM includes several additional codes if HIV occurs in the setting of pregnancy:

B20 Human immunodeficiency virus [HIV] disease

Includes: Acquired immunodeficiency syndrome [AIDS]

  AIDS-related complex

  HIV infection, symptomatic

Code first Human immunodeficiency virus [HIV] disease complicating pregnancy, childbirth, and the puerperium, if applicable (O98.7-)

Use additional code(s) to identify all manifestations of HIV infection

Excludes 1: Asymptomatic human immunodeficiency virus [HIV] infection status (Z21)

  Exposure to HIV virus (Z20.6)

  Inconclusive serologic evidence of HIV (R75)

O98.7 Human immunodeficiency virus [HIV] disease complicating pregnancy, childbirth, and the puerperium

Use additional code to identify the type of HIV disease:

  Acquired immune deficiency syndrome (AIDS) (B20)

  Asymptomatic HIV status (Z21)

  HIV positive NOS (Z21)

  Symptomatic HIV disease (B20)

 O98.71 Human immunodeficiency virus [HIV] disease complicating pregnancy

  O98.711 Human immunodeficiency virus [HIV] disease complicating pregnancy, first trimester

  O98.712 Human immunodeficiency virus [HIV] disease complicating pregnancy, second trimester

  O98.713 Human immunodeficiency virus [HIV] disease complicating pregnancy, third trimester

  O98.714 Human immunodeficiency virus [HIV] disease complicating pregnancy, unspecified trimester

 O98.72 Human immunodeficiency virus [HIV] disease complicating childbirth

 O98.73 Human immunodeficiency virus [HIV] disease complicating the puerperium

Example 1: A man with HIV-1 infection presents with neurocognitive dysfunction without behavioral disturbance. After evaluation, the diagnosis is HIV-associated dementia. Diagnosis codes for this patient are:

ICD-9-CM

042 Human immunodeficiency virus (HIV) disease

294.10 Dementia in conditions classified elsewhere without behavioral disturbance

ICD-10-CM

B20 Human immunodeficiency virus [HIV] disease

F02.80 Dementia in other diseases classified elsewhere without behavioral disturbance

Example 2: A woman with HIV is in her third trimester of pregnancy and presents with a distal sensory neuropathy. The final diagnosis is HIV-associated neuropathy. Diagnosis codes for this patient are:

ICD-9-CM

647.63 Infectious and parasitic conditions in the mother classifiable elsewhere, but complicating pregnancy, childbirth, or the puerperium; other viral disease; antepartum condition or complication

042 Human immunodeficiency virus (HIV) disease

357.4 Polyneuropathy in other diseases classified elsewhere

ICD-10-CM

O98.713 Human immunodeficiency virus [HIV] disease complicating pregnancy, third trimester

G63 Polyneuropathy in diseases classified elsewhere

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REFERENCES

1. Centers for Medicare and Medicaid Services (CMS), National Center for Health Statistics (NCHS). ICD-9-CM official guidelines for coding and reporting. www.cdc.gov/nchs/data/icd9/icd9cm_guidelines_2011.pdf. Updated October 1, 2011. Accessed May 8, 2012.

2. Centers for Medicare and Medicaid Services (CMS), National Center for Health Statistics (NCHS). ICD-10-CM official guidelines for coding and reporting 2012. www.cdc.gov/nchs/data/icd10/10cmguidelines2012.pdf. Updated October 1, 2011. Accessed August 22, 2012.

© 2012 American Academy of Neurology

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