# HIV vs AIDS



## mcdream (Jul 22, 2019)

Clarification please regarding assigning Z21 vs B20 in the outpatient setting:
-Does "HIV-related illness" mean opportunistic infection? 
-What MUST the provider document in order to assign B20 instead of Z21?

2019 ICD-10-CM DGs state: Previously diagnosed HIV-related illness
Patients with any *known prior diagnosis of an HIV-related illness* should be coded to B20.
*Once a patient has developed an HIV-related illness*, the patient should always be assigned B20 on every subsequent admission/encounter.
*Patients previously diagnosed with any HIV illness* (B20) should never be assigned to R75 or Z21, asymptomatic HIV infection status.

Question: Is my understanding of this guideline correct...
*B20*: In order to assign B20 (symptomatic HIV/AIDS/ARC), the *patient must have HAD a previous HIV-related illness* (a.k.a opportunistic infection).  The *provider MUST document either AIDS or HIV with history of related illness* (opportunistic infection).
*Z21*: If the *patient has NOT had an HIV-related illness* (a.k.a opportunistic infection) the patient should be assigned Z21, asymptomatic HIV infection status.

Link to CDCs list of the most common OIs (opportunistic infections) for people living in the United States


			https://www.cdc.gov/hiv/basics/livingwithhiv/opportunisticinfections.html
		


I appreciate your guidance!


----------



## Munzueta (Jul 23, 2019)

Yes, that is one way of seeing the B20 code with opportunistic infections. 

So in other words, lets say this is what you have.

Patient being seen today for HIV with CMV (Cytomegaloviral disease) for a follow-up and medication management.
Since this is an HIV related illness (opportunistic) then this would be coded as B20 (always first) followed by the code of the related condition (B25.9)
In other words B20 is used when there are "symptoms" of a new disease related to HIV.

Z21 is "asymptomatic" meaning there are no symptoms shown at the moment.
Patient is being seen for iron def anemia. Patient is also status positive HIV test on Atripla with no symptoms. 
D50.9 would be use for the anemia and Z21 for asymptomatic HIV.

Also, if you refer to your guidelines on Chapter 1 on your ICD-10-CM it provides some keywords to look for when a patient is given a diagnosis of HIV and no symptoms are documented,
such as "HIV positive"
"known HIV"
"HIV test positive" or similar terminology, again this is coming from the guidelines.

hope this helps!


----------



## mcdream (Jul 23, 2019)

Munzueta said:


> Yes, that is one way of seeing the B20 code with opportunistic infections.
> 
> So in other words, lets say this is what you have.
> 
> ...


Thank you Munzueta! You mentioned "that is one way of seeing the B20 code with opportunistic infections" is there another way to assign B20 other than with documented current &/or history of opportunistic infection(s)?

Also once a B20 always a B20 even if opportunistic infection(s) no longer present at time of current encounter?
So...
B20= HIV positive with current &/or history of HIV-related illness (opportunistic infection)?
Z21= HIV positive without current &/or history of HIV-related illness (opportunistic infection)?

TIA for your continued guidance!


----------



## Munzueta (Jul 24, 2019)

Yes once a patient has been diagnosed with HIV, it will always be coded as HIV.

if at the time of the encounter there is no current opportunistic infection and there is nothing going on, then you might be looking at Z21.


----------



## Kristen Bensel (Jul 24, 2019)

I completely understand the confusion! HIV coding is incredibly difficult.  And like you mention the guidelines on this condition are about as clear as mud!

However, I think it depends on the documentation you have to code from. If the provider indicated the patient had a history of an infection that had resolved, I would be inclined to think the B20 would be most appropriate, with a history of code. But if only HIV (or something to that effect is documented) then you would have to code by the available information, which would probably lead you to Z21. 

If you feel that you need to query a provider for more information, keep in mind that the provider may need some more education understanding the documentation requirements for this condition under ICD-10. To a provider HIV is an active infection. So if you ask for more clarification of what the infection is to code with B20, you may end up going round and round. (I speak from experience on this exact situation 

Hope my two cents are of some help.


----------

