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