What’s the difference between B20 and Z21? Which is right for positive HIV status?

In this post

• ICD-10-CM diagnosis coding for positive HIV status
• Update to HIV coding in 2022
• Medical practice reimbursement for individual claims based on CPT®
• Risk adjusted factor for coding medical claims
• HCC Model
• Common HIV diagnosis codes
• ICD-10 general guidelines

Question: 

For an HIV positive patient without symptoms, is the correct diagnosis code Z21 or B20?  What difference does it make to reimbursement?

Answer: 

Following ICD-10 guidelines, a patient with HIV status without symptoms is coded with Z21, positive HIV status.

Some doctors and non-physician practitioners would prefer to use B20. According to ICD-10, B20 is used when the patient has confirmed AIDS.

Following ICD-10 guidelines, if a patient has or has had an HIV related condition, use B20 AIDS.  If the patient has a positive HIV status, without symptoms or related conditions, use Z21.  See the excerpts from the ICD-10-CM General Guidelines, below.

Update to HIV coding in 2022

Changes to ICD-10-CM coding are effective October 1. The 2022 changes are effective October 1, 2021, even though we call them the 2022 year codes and changes. This year, there is a new guideline for coding HIV/AIDS when the patient is on an anti-retroviral drug. This is from the Official Guidelines.

(i) History of HIV managed by medication

If a patient with documented history of HIV disease is currently managed on antiretroviral medications, assign code B20, Human immunodeficiency virus [HIV] disease. Code Z79.899, Other long term (current) drug therapy, may be assigned as an additional code to identify the long-term (current) use of antiretroviral medications.

• A patient with known HIV who is taking antiretroviral medications is now code with B20, not Z21.

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