Question

Medical Coding Scenario:

45-year-old HIV positive male has a fever and shortness of breath. A diagnostic workup including a chest X-ray and sputum culture was done. The results provided a diagnosis of Pneumocystis pneumonia. The doctor documented Pneumocystis pneumonia due to AIDS.

1. What conditions will you code for this scenario and why?

2. Is there a related coding guideline that you think may apply when determining the codes? You do not have to provide the codes. Just the conditions that you think will get coded in this case and guideline that gives you direction to code it.

3. What did you find about HIV coding from the guidelines?

Answer 1

1. The conditions that causes fever and shortness of breath include:

VIRAL;

• CMV(Cytomegalovirus) infection[these does not cause problems unless patient have weak immune system like in case of AIDS, Pregnancy.
• Toxoplasma gondii parasite can cause toxoplasmosis, a condition leading to lung problems resembling Tb and pneumonia.

BACTERIAL;

• Haemophilus species
• Mycobacterium
• Streptococcus pneumonia

FUNGAL;

• Aspergillus fumigatus
• Blastomyces dermatitidis
• Coccidioides immitis
• Cryptococcus neoformans
• Pneumocystis jirovecii(this case)

​​​​​​​CANCERS: Some cancers like Kaposi sarcoma, Non-Hodgkin lymphoma also causes fecer and shortness of breath in HIV patients.

2. Coding guidelines are specific for each conditions associated with HIV infection. At least 2 codes are required to complete coding of patients with an HIV related illness: first code being that of the HIV and the second for the specific associated conditions which can be:

• pneumonia
• Tb
• Sepsis
• Candida stomatitis(thrush)
• Herpes zoster
• Encephalopathy
• Anemia
• Underweight
• Acute lymphadenitis
• Arthropathy
• Splenomegaly
• Weakness

​​​​​​​3. HIV coding: According to ICD-10-CM coding guidelines :

Code Z21 is used for patients who are asymptomatic, meaning they are HIV positive but have never had an HIV-related condition. Once that patient experiences an HIV-related condition, the Z21 code is no longer appropriate.

Patients who are HIV positive with any known prior diagnosis of an HIV related illness should be coded to code B20. Only confirmed cases are coded using code B20. Once coded B20, they will never go back to Z21.

Patients with inconclusive serology reports are assigned code R75