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Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

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

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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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- Betsy Nicoletti
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In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions.