Home Health ICD-9/ICD-10 Alert

Hint: All states do not treat AIDS codes equally.

Do you know if your state rejects your OASIS records when you submit them with AIDS as the primary diagnosis? Many coders don't, and they wind up with problems down the line.

If you're admitting a patient with AIDS, you probably know you would code AIDS as primary only when you are addressing multiple aspects of the diagnosis. And if the patient is experiencing complications of AIDS, coding guidelines direct you to code AIDS first, followed by the complication. But even if you follow these rules, you could be wrong.

Snag: To protect individual privacy, many states prohibit the electronic transmission of ICD-9-CM codes for HIV and sexually transmitted diseases, a spokesperson for the Centers for Medicare & Medicaid Services acknowledges. "It's not a federal regulation, but we accommodate states if their rules are stricter," the spokesperson says. The OASIS system includes a switch that each state's OASIS automation coordinator can turn on or off, depending on state requirements, the staffer tells Eli.

Result: When you transmit an OASIS record, the state OASIS system removes all the prohibited codes before the record is validated. Therefore, when HIV, AIDS or STD codes are listed as the primary diagnosis in states that don't allow them, the system erases the codes, leaving the primary diagnosis field empty. The system then generates a fatal record message, stating that the (M0230) primary diagnosis field cannot be blank, explains the Wisconsin Department of Health and Family Services.

Solution: To permit record transmission, the agency should contact the patient's physician to determine a specific diagnosis for which the patient is being treated or use a secondary or "next best" diagnosis as the primary reason you are providing services, DHFS suggests.

Often you can code the complication first, rather than the AIDS, if your agency is in one of the affected states, says coding consultant Lisa Selman-Holman with Denton, TX-based Selman-Holman & Associates. For example, even though coding guidelines say you should code 042 (Human immunodeficiency virus [HIV] disease) followed by 136.3 (Pneumocystosis), you would reverse the order if you live in a state that restricts electronic transmission of HIV codes, she illustrates.

Tip: You may also include HIV as a status code - V08 - when a patient is an asymptomatic carrier, and is in home care for some other diagnosis. 
 
Check your state's requirement: The following states do not transmit HIV/AIDS/STD diagnosis codes, a CMS spokesperson tells Eli: Alaska, Arizona, California, Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Idaho, Illinois, Iowa, Maryland, Michigan, Mississippi, Montana, New Jersey, New Mexico, Nevada, North Dakota, Oregon, Puerto Rico, South Carolina, Texas, US Virgin Islands, Utah, Washington, West Virginia, Wisconsin and Wyoming.