Q on the hiv codes, when do you use the z code versus the b code would you code the patient as being active if they have history of hiv a when we start looking at the aids and hiv codes, we originally received this question that came asking, when do we use that z code versus when do we use the 042 in icd9 so we went update it for icd10.I’m reiterating some of the information that tammy and alicia covered when they covered this topic back in august, but i looked at it from a little bit different perspective.
You’ll find i’m huge on citing my sources, so i wanted to give you where i found the information that helped me make my decision in when do i use the z code, the z21 versus the b20.When we first start looking at hiv, the important thing to understand here is that a patient at this point in time cannot have a history of hiv, it’s not possible.We do not yet have a cure for hiv.Once the patient has hiv, they have hiv for life.From a coding.
Perspective, it simplybecomes do they have symptomatic hiv or do they have asymptomatic hiv we’ll scroll down a little bit farther and we’re going to talk about how do we figure out what constitutes asymptomatic, which is the z21, versus what constitutes symptomatic, which is b20.It was funny because when we were looking at our answer sheets earlier today, alicia goes, i love this little timeline thing, how do you get that i said, the cdc website because that’s actually where this came from.What i did is, if you didn’t.
Know this, the federal government, our federal government here in the united states has a website devoted to aids and hiv because for years it was so rampant and it’s still a very large thing that we have to deal with.They actually estimate that up to 18 of the population that has hiv has no idea that they have hiv because they’re asymptomatic.What they explained is that there are really three stages of hiv.There’s the acute infection point where the person first gets infected and their body, it’s a virus so it’s replicating constantly.That’s that acute infection.
Timeframe.Usually, they might have some flulike symptoms.It’s going to be a bad flu, it’s not going to be, oh, that was a piece of cake.That’s kind of all the more they’re going to get.They’re not going to know.It’s not going to be any abnormal, crazy, oh, i must have hiv, that’s what this is.Then, they fall into a period of what we call al latency.That means that the virus is just there, doing its thing replicating, not making them sick but continuing to spread.
Throughout their bloodstream.It’s reproducing at a lower level than that initial thing, but it’s still considered active infection.Both of these, we’re still talking about an asymptomatic patient.They have not yet had a symptom related to their hiv.When we talk about symptoms related to their hiv, cdc actually defines aids, their cd4 cells fall below 200 cells and that’s when it’s progressed to aids.They actually go up to explain that it’s not just the cd4 blood counts, it’s actually about whether or not a patient has had what we call an oi or an opportunistic infection.
Those first two stages, the acute infection, the al latency, we don’t have any symptoms associated with those.Yeah, they thought they had the flu, but it’s not necessarily asymptomatic, it’s not an opportunistic infection.When we start looking through here, the guidelines actually say, ok, if they’ve not had a symptom of hiv, they’re asymptomatic.Usually, the provider is going to call this hiv positive, known hiv, they have a history of an hivpositive test.The important thing to note here is this is not where the provider uses the phrase aids,.
And i did not put this in this note, but this was a question that i have had people ask me as i’ve done trainings, this is not if a provider writes the word arc aidsrelated complex.That’s actually a lot of providers in the infectious disease world will call it arc when the patient is first beginning to experience an opportunistic infection, which is an hivrelated illness.Notice both of these guidelines for symptomatic and asymptomatic revolve around has the patient had, either currently or in the past an hivrelated illness if they’ve had an hivrelated illness,.
They get coded as symptomatic hiv.The aids.Gov website goes on to explain an hivrelated illness is these opportunistic infections sometimes referred to as oi.The aids.Gov web address actually says there are 20 opportunistic infections that by default, if you have a patient with known hiv, since the time of their diagnosis with hiv has had one of these conditions, they have fullblown aids.Period.Once they have aids, they have aids for the rest of their life.Once they go from that z21, that asymptomatic status to having an opportunistic infection, they.
Move into the b20 world.They stay in that b20 world for life.Even if we treat that opportunistic infection and it goes away, things like.If you’ll scroll a little farther up, it will give you that full list of b20.When we talk about opportunistic infections, these are things that take advantage of the patient’s weakened immune system.I think about it as, it’s going to take a patient nearly to death’s door, and it could potentially be fatal for them.If we start looking at these, think about this.Candidiasis of bronchi, trachea, esophagus, lungs, that’s a fungal.
Infection down in there.A patient with aids or with hiv has a compromised immune system, they’re not going to be able to fight off these infections as well as a normal healthy patient would.By definition, if a patient has hiv, and they have or since the time of their diagnosis has had one of these 20 conditions, they have aids, they have fullblown aids.The most common question i get is, well, the didn’t call it aids.If the documents known hiv and then the history it says history of invasive cervical cancer.At a bare.
Minimum, you need to be querying the provider and going, was that before or after their hiv diagnosis is it related because if it’s related, that patient has aids, they should be reported using b20.That’s one of the things i see most frequently.I see a lot of coders go, well, the didn’t say that, the just said this.It comes down to understanding the disease process and knowing these different pieces to know what to look for in the record.Because yeah, the may have said down here hiv positive, but in the history they may have.
Said hiv positive with a history of histoplasmosis.Well, i got news, histoplasmosis is almost always hivrelated.You need to know when to ask the questions of your providers and by asking those questions, you’re going to begin to i know this sounds funny you’re going to begin to train most providers as to what needs to be there when they’re diagnosing aids and hiv.Another common question i get is, what if our doesn’t know that they’ve had one of these opportunistic infections and just write hiv positive’ and i coded.
It as a z21.We already have that problem with the icd9 codes that we did before we went to icd10, the same process is likely to occur.If you’re not familiar with that process, when you report those codes to the insurance company they’re looking at their files and they’re going, oh, but we showed that this patient actually has aids.More than likely, what happens is you get a letter from the insurance company saying, according to our records, this is a patient with fullblown aids.Please verify your documentation.
So that you know, oh! we need to get clarification from the patient or from the patient’s past medical records, but it looks like we need to adjust our diagnosis because they don’t really just have hiv, they have fullblown aids.Oftentimes, is that the provider doesn’t know the nuances and the differences from a coding perspective, because remember, coding and al don’t always match 100.We’ve got to come to that common language and explain how it’s different from a coding perspective.For aids and hiv, when we talk about b20 and z21, it’s all about are they symptomatic.
Or asymptomatic, which comes down not to their blood cell counts but have they had an opportunistic infection or hivrelated illness.Laureen just a few clarifying questions that came in.Lina is asking if the patient is being treated for cancer, we don’t need to report their hiv status chandra i would disagree with that statement.Every insurance company and actually the coding rules, the way that they have always been explained to me, even if you look in the icd10 guidelines, hiv is the only condition that is considered to always be ally significant.
It’s expected to be reported on every encounter for every provider that sees that patient from the time of diagnosis until the time they expire because it does factor in to so many things and there’s such a high risk around transmission, but that is the one disease that they track extremely closely.I would encourage you to report it on any hiv patient that you see.Laureen debbie said, so, hiv is either asymptomatic or symptomatic, no personal history of chandra correct because we can’t cure it yet.Laureen candy said i’ve always heard that if the patient has hiv in their past.
History, you always have to code for hiv.Is that true chandra yes.Because again, hiv never goes away.At this point in time, it can’t be cured.It can be controlled with medications especially if we catch it in the asymptomatic phase, but once they have hiv, like i said because we don’t have a cure yet, they have hiv for life.It’s the one condition that’s always considered ally significant, so it needs to be reported any time that patient is seen.The order simply changes depending on why they’re there.
If you have a patient coming in and this goes back to the icd10 guidelines, those chapter 1 guidelines.You have a patient coming in for an hivrelated illness, maybe they’re coming in for histoplasmosis, maybe they’re coming in for a kaposi sarcoma.Those are things that are inherently hivrelated.The guidelines tell you, ok, the hiv has to go first.If they’re coming in for something completely unrelated, maybe they sprained their ankle, oh, i sprained my ankle, i need you to take a look at my ankle, but they find out during the intake this patient is hiv positive.They don’t have aids, they.
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