OASIS Alert

Published on Thu Jul 07, 2005 PDF

Know your state law before making HIV primary.

Depending on where you live, your state may reject OASIS records that include HIV or AIDS in M0230.

If you're admitting a patient with AIDS, you probably know you would code AIDS as primary only if 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: 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. For this reason, when HIV, AIDS or STD codes are listed as the primary diagnosis, the system generates a fatal record message. The message indicates that the (M0230) primary diagnosis field cannot be blank, because the record appears not to have a primary diagnosis, 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, for a patient with HIV complicated by pneumocystosis, coding guidelines say you should code 042 (Human immunodeficiency virus [HIV] disease) followed by 136.3 (Pneumocystosis). But in Texas - which restricts electronic transmission of HIV codes - you would reverse the order, she illustrates.

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

Note: For expert information on home health diagnosis coding, order Eli's Home Health ICD-9 Coding Alert at 1-800-874-9180.