Health Information Management

Review HIV coding to ensure compliance

HIM-HIPAA Insider, August 2, 2011

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Coding and sequencing HIV can be challenging for coders, so it's no surprise that CMS identified it as an area of compliance risk in the April Medicare Quarterly Compliance Newsletter. Following are some guidelines to help coders correctly sequence HIV codes.

  • When a patient is admitted for an HIV-related condition, report ICD-9-CM code 042 (HIV) as the principal diagnosis, followed by additional diagnosis codes for all reported HIV-related conditions.
  • When a patient is admitted for an AIDS-related condition, report ICD-9-CM code 042 as the principal diagnosis. AIDS-related conditions include those on the Major Diagnostic Category 25 list (HIV infections) or those that are tied to AIDS by a physician in his or her documentation.
  • When a patient is admitted for an unrelated illness (e.g., a traumatic injury), report the unrelated illness (the nature of the injury) as the principal diagnosis, then report ICD-9-CM code 042, and any codes for HIV-related conditions as secondary diagnoses.
  • When a patient has a known prior diagnosis of an HIV-related illness, report ICD-9-CM code 042 on every subsequent admission/encounter, but not necessarily as principal diagnosis.
Editor’s note: These tips originally appeared in the August issue of Briefings on Coding Compliance Strategies.



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