Thank you. Yes, but my medical director is stating that even though the medical records states, "no AIDS criteria met", as long as the patient is on the retroviral medications, then that patient has AIDS. I am not debating the clinical aspect, just the coding documentation aspect. After reading the above documentation would you allow the provider to code B20 or Z21?
"no AIDS criteria met" is another way of saying it's not an AIDS diagnosis. The use of antiretroviral meds doesn't justify a diagnosis of AIDS on its own. I think the medical director is making a blanket-statement in this case. For example, a patient takes Valtrex every day to prevent outbreaks. Usually it's discovered that the patient has the condition which prompts the use of the Valtrex. However, it's certainly possible that a person can test positive for a certain type of herpes, say during an STD screening, and starts taking the Valtrex to try to prevent any outbreaks from happening, even though they haven't had one nor do they know that they will ever get an outbreak. More than likely the meds probably came into play after an illness/outbreak, but it would be inaccurate to assume that's the case for everybody, if that makes sense.
"HIV is treated using a combination of medicines to fight HIV infection. This is called antiretroviral therapy (ART). ART isn’t a cure, but it can control the virus so that you can live a longer, healthier life and reduce the risk of transmitting HIV to others. ART is recommended for all people with HIV, regardless of how long they’ve had the virus or how healthy they are. If left untreated, HIV will attack the immune system and
eventually progress to AIDS."
"Treatment with antiretroviral drugs does not necessarily mean a patient has progressed from HIV-positive status to full-blown AIDS, since the CDC recommends that all HIV-positive patients be treated with antiretrovirals."
Even though the narrative states no complaints, the diagnosis would really depend on the history of the HIV. If it has always been asymptomatic, then Z21 would be accurate. The use of antiretrovirals alone can't really be used to define a B20 diagnosis because a patient may have always been asymptomatic and is taking the meds proactively in a sense. There would need to be a documented linkage between the use of the meds AND a previous HIV related illness to meet the criteria for B20.
In my opinion, based on the narrative, there is nothing documented to substantiate using B20. The use of the meds is irrelevant without further elaboration as I mentioned above.