HIV positive versus AIDS coding

[Darlene]

Here is a practice test question that I had and got wrong. "A 20-year-old HIV-positive patient was admitted to a hospital observation bed by his PCP for stomach cramps and diarrhea. After tests were completed, the PCP determined that the stomach cramps and diarrhea were results of staphylococcal food poisoning. Select the appropriate diagnoses codes for this patient.
a. 042, 005.0
b. V08, 005.3
c. 005.0, 042
d. 042, V08, 005.3

 

[Carolyn Heath]

Darlene, this question is also on the AAPC group on Facebook. I always get confused when it comes to this type of question, but I will try to answer it. You would not put 042 and V08 together, so D is automatically eliminated. If the patient is HIV-positive and showed no symptoms of the infection, you would use V08. If the patient has AIDS (the term AIDS must be used) or being treated for HIV-related illness or having any condition resulting from HIV positive status, you would use 042. This came right out of the guidelines under Chapter 1A. A and C would be eliminated because the patient is HIV-positive and has not displayed any symptoms of the infection. The correct answer is B.

 

[Darlene]

How is staphylococcal food poisoning related to AIDS. I believe that none of these answers are correct. I would go with C if it had V08 instead of 042.

 

[Carolyn Heath]

Darlene, after looking at the case again and rethinking my answer, I would have to agree with you. Plus someone on the AAPC Facebook Group helped me understand how to sequence the codes when a patient who has HIV-positive or AIDS is being observed for something that is not in relation to the HIV virus or AIDS.

 

[williamcarter]

nice post.good

 

[Ruth Sheets]

This was discussed in the December 2012 Q&A Webinar. View the replay atwww.cco.us and click on Q and A Webinar Replay link. This is a replay club so you get access to all the past replays as well as future ones.


Here are some key points that Alicia provided:
You can figure this answer out pretty quickly by knowing just a few things.
1. Does your patient have HIV or AIDS?

• V08 is AIDS (confirmed)
• 042 is HIV positive

2. What made your patient sick?

• Staphylococcus 005.0
• Clostridia 005.3
• Is it an AIDs related Dx: Pneumocystis carinii pneumonia (PCP), Kaposi’s sarcoma & lymphoma, AIDS-related complex (ARC) These change HIV to AIDS

3. The most important thing to know. Code placement!

• OGCR Section I.C.I.a and b

If a person is admitted for an HIV related condition the HIV (042) is coded first, condition second. If a person is admitted for a non-related HIV (042) condition it is coded first and HIV second.

 

[Carolyn Heath]

Another question: What if the patient is admitted and has AIDS? Do we code the same as #3 except use V08 instead of 042? Thanks!

 

[Alicia Scott]

Well Carolyn, that is an excellent question. You would not use V08 and 042 together. If a person has AIDs then it is known they are HIV positive.

 

[Carolyn Heath]

Thank you, Alicia!

 

[Alicia Scott]

Just for everyone I can almost guarantee there will be a question on the CPC exam about V08 and 042.

 

[Luna]

This weeks studies is taking me through the HIV guidelines.
The way I understand it "V08 is AIDS (confirmed)" is not a correct statement. (Made above.)

042 is AIDS

042 is HIV infection symptomatic. It's placement will depend on whether the reason for the encounter is due to a HIV-related condition or unrelated condition. AIDS does not have to be confirmed for 042 to be used. Once a patient has a history of HIV positive symptom(s) you would use code 042 on every subsequent encounter regardless of the reason for the encounter- only its placement would vary.

V08 is HIV positive asymptomatic. Meaning patient has no history of HIV-related symptoms but is listed as "HIV positive", "known HIV", "HIV test-positive". Once that person presents with HIV-related symptom(s) then his status as asymptomatic changes and the code becomes 042 and will never go back to V08. The patient is now considered HIV infection symptomatic and can never go back to asymptomatic. This change in status though does not mean they have AIDS. Only that it has been recognized that the virus has begun its course even if in future they are again presenting without an HIV-related condition. Confirmation of AIDS is not necessary to use code 042. Even though HIV infection symptomatic and AIDS are not the same thing they do share the same code (042).

But, it is extremely important to never make the mistake of coding an individual who is HIV positive asymptomatic with 042.

Likewise it is important to understand that HIV and AIDS although coded 042 are not the same thing. They are just buddies, I guess, because you can't get the one without first getting the other.

BTW, does anyone know if in ICD-10, they have assigned HIV infection symptomatic and AIDS each their own unique codes?

 

[Carolyn Heath]

Luna, I have the AAPC 2013 ICD-10 Draft Coding Manual and I went to the guidelines to find the codes for HIV and AIDS and then I looked up the codes. Here is what I found: HIV in ICD-10 is B20 which includes HIV infection symptomatic and AIDS. For HIV Positive or Asymptomatic HIV in ICD-10, it is Z21.

 

[Alicia Scott]

You can check out ICD-10-CM codes with Supercoder, FindACode and the AAPC. They all have ICD-10-CM crosswalks. Happy searching.

 

[Carolyn Heath]

I have not subscribe to Supercoder or findACode, but I can certainly use AAPC if necessary to find the ICD-10-CM code.

 

[Alicia Scott]

At the college I had the students use the AAPC site to do ICD-10-CM. We only had one draft at the time. Not all the codes translate though because of ICD-10-CM being more specific. That is when you pull out a book.