ICD-10-CM Guidelines: Certain
Infectious and Parasitic Diseases (A00-
B99) Questions & Answers
HIV Code Selection and Sequencing: Code only confirmed cases of HIV Infections -
ANSWERS- Code only confirmed cases of HIV infection/illness.
- This is an exception to the hospital inpatient guideline Section II, H.
- In this context, "confirmation" does not require documentation of positive serology or
culture for HIV; the provider's diagnostic statement that the patient is HIV positive, or
has an HIV-related illness is sufficient
HIV Code Selection and Sequencing: Patient admitted for HIV-related condition -
ANSWERS(1) principal diagnosis: B20, Human immunodeficiency virus [HIV] disease
(2) followed by additional diagnosis codes for all reported HIV-related conditions
HIV Code Selection and Sequencing: Patient with HIV disease admitted for unrelated
condition (such as a traumatic injury) - ANSWERS(1) principal diagnosis: the code for
the unrelated condition (e.g., the nature of injury code)
(2) B20
(3) followed by additional diagnosis codes for all reported HIV-related conditions
HIV Code Sequencing: When was the patient diagnosed? - ANSWERS- Whether the
patient is newly diagnosed or has had previous admissions/encounters for HIV
conditions is irrelevant to the sequencing decision.
HIV Code Selection: Asymptomatic human immunodeficiency virus (Z21) - ANSWERS-
Z21, Asymptomatic human immunodeficiency virus [HIV] infection status
- applied when the patient without any documentation of symptoms is listed as being
"HIV positive," "known HIV," "HIV test positive," or similar terminology.
- Do not use this code if
, a. the term "AIDS" is used
b. the patient is treated for any HIV-related illness, use B20 instead
c. the patient is described as having any condition(s) resulting from his/her HIV positive
status; use B20 instead
HIV Code Selection: Patients with inconclusive HIV serology, but no definitive diagnosis
or manifestations of the illness - ANSWERS- R75, Inconclusive laboratory evidence of
human immunodeficiency virus [HIV]
HIV Code Selection: Patients with any known prior diagnosis of an HIV-related illness -
ANSWERS-should be coded to B20
- Once a patient has developed an HIV-related illness, the patient should always be
assigned code B20 on every subsequent admission/encounter.
- should never be assigned to R75 or Z21, Asymptomatic human immunodeficiency
virus [HIV] infection status.
HIV Code Selection: Patient's admitted during pregnancy, childbirth or the puerperium
(or presenting for a health care encounter) because of an HIV-related illness -
ANSWERS(1) principal diagnosis code of O98.7-, Human immunodeficiency [HIV]
disease complicating pregnancy, childbirth and the puerperium
(2)followed by B20 and the code(s) for the HIV-related illness(es).
- Codes from Chapter 15 always take sequencing priority.
HIV Code Selection: Patients with asymptomatic HIV infection status admitted (or
presenting for a health care encounter) during pregnancy, childbirth, or the puerperium -
ANSWERS(1) principal diagnosis code of O98.7-, Human immunodeficiency [HIV]
disease complicating pregnancy, childbirth and the puerperium
(2) followed by Z21
- Codes from Chapter 15 always take sequencing priority.
HIV Code Selection: Encounters for testing for HIV - If a patient is being seen to
determine his/her HIV status, - ANSWERS(1) use code Z11.4, Encounter for screening
for human immunodeficiency virus [HIV].
(2) Use additional codes for any associated high risk behavior.
HIV Code Selection: Encounters for testing for HIV - If a patient with signs or symptoms
is being seen for HIV testing - ANSWERS(1) code the signs and symptoms
(2) An additional counseling code Z71.7, Human immunodeficiency virus [HIV]
counseling, may be used if counseling is provided during the encounter for the test.
Infectious and Parasitic Diseases (A00-
B99) Questions & Answers
HIV Code Selection and Sequencing: Code only confirmed cases of HIV Infections -
ANSWERS- Code only confirmed cases of HIV infection/illness.
- This is an exception to the hospital inpatient guideline Section II, H.
- In this context, "confirmation" does not require documentation of positive serology or
culture for HIV; the provider's diagnostic statement that the patient is HIV positive, or
has an HIV-related illness is sufficient
HIV Code Selection and Sequencing: Patient admitted for HIV-related condition -
ANSWERS(1) principal diagnosis: B20, Human immunodeficiency virus [HIV] disease
(2) followed by additional diagnosis codes for all reported HIV-related conditions
HIV Code Selection and Sequencing: Patient with HIV disease admitted for unrelated
condition (such as a traumatic injury) - ANSWERS(1) principal diagnosis: the code for
the unrelated condition (e.g., the nature of injury code)
(2) B20
(3) followed by additional diagnosis codes for all reported HIV-related conditions
HIV Code Sequencing: When was the patient diagnosed? - ANSWERS- Whether the
patient is newly diagnosed or has had previous admissions/encounters for HIV
conditions is irrelevant to the sequencing decision.
HIV Code Selection: Asymptomatic human immunodeficiency virus (Z21) - ANSWERS-
Z21, Asymptomatic human immunodeficiency virus [HIV] infection status
- applied when the patient without any documentation of symptoms is listed as being
"HIV positive," "known HIV," "HIV test positive," or similar terminology.
- Do not use this code if
, a. the term "AIDS" is used
b. the patient is treated for any HIV-related illness, use B20 instead
c. the patient is described as having any condition(s) resulting from his/her HIV positive
status; use B20 instead
HIV Code Selection: Patients with inconclusive HIV serology, but no definitive diagnosis
or manifestations of the illness - ANSWERS- R75, Inconclusive laboratory evidence of
human immunodeficiency virus [HIV]
HIV Code Selection: Patients with any known prior diagnosis of an HIV-related illness -
ANSWERS-should be coded to B20
- Once a patient has developed an HIV-related illness, the patient should always be
assigned code B20 on every subsequent admission/encounter.
- should never be assigned to R75 or Z21, Asymptomatic human immunodeficiency
virus [HIV] infection status.
HIV Code Selection: Patient's admitted during pregnancy, childbirth or the puerperium
(or presenting for a health care encounter) because of an HIV-related illness -
ANSWERS(1) principal diagnosis code of O98.7-, Human immunodeficiency [HIV]
disease complicating pregnancy, childbirth and the puerperium
(2)followed by B20 and the code(s) for the HIV-related illness(es).
- Codes from Chapter 15 always take sequencing priority.
HIV Code Selection: Patients with asymptomatic HIV infection status admitted (or
presenting for a health care encounter) during pregnancy, childbirth, or the puerperium -
ANSWERS(1) principal diagnosis code of O98.7-, Human immunodeficiency [HIV]
disease complicating pregnancy, childbirth and the puerperium
(2) followed by Z21
- Codes from Chapter 15 always take sequencing priority.
HIV Code Selection: Encounters for testing for HIV - If a patient is being seen to
determine his/her HIV status, - ANSWERS(1) use code Z11.4, Encounter for screening
for human immunodeficiency virus [HIV].
(2) Use additional codes for any associated high risk behavior.
HIV Code Selection: Encounters for testing for HIV - If a patient with signs or symptoms
is being seen for HIV testing - ANSWERS(1) code the signs and symptoms
(2) An additional counseling code Z71.7, Human immunodeficiency virus [HIV]
counseling, may be used if counseling is provided during the encounter for the test.
