Question

This is a 35-year-old HIV-positive male with progressive lymphadenopathy and unexplained fever, night sweats, and chills. Low osmolar CT scan of the chest, abdomen, pelvis, and neck showed extensive lymphadenopathy involving mediastlnum and left hilum, paratracheal nodal chains, retroperiteoneum, right iliac nodal chains, and right inguinal nodes. There were several areas of atelectasis evident in the lung. CT guided needle biopsy of an emerged mediastinal node that was suspicious for tuberculosis. This was accomplished using visipaque contrast. The node in fact was AFB-positive. The patient was placed on respiratory isolation and serial sputums were obtained. The patient’s sputum contained positive AFB on concentrated specimen. Also, during the hospitalization, the patient complained of swelling in the bilateral lower extremities. Dopplers were negative for DVT. The patient was diagnosed with tuberculosis of intrathoracic, retroperitoneum, and Inguinal lymph nodes, tubercle bacilli found by microscopy. The patient will be referred to the clinic for management of his HlV disease and associated tuberculosis. What codes are assigned?

Need help with ICD-10-CM Code with POA indicator and MS'DRG and lCD-10-PCS Code.

Answer 1

Present on admission Exempt ICD 10 CM codes ,

Present on admission is defined as present at the time the order for inpatient admission occurs - conditions that devlop during an outpatient encounter , including emergency department , observation or outpatient encounter including emergency department , observation or outpatient surgery are considered POA .

POA indicator is a billable / specific ICD -10 CM code that can be used to indicate a diagnosis for reimbursement purposes ,

Codes

• Human immunodeficiency virus
• HIV in pregnancy
• HIV cdc category a3
• Hiv cdc category b3
• Hiv cdc category c1
• hiv cdc categort c2
• Hiv cdc category c3
• Hiv infection symptomatic
• Hiv infection symptomatic b1
• Hiv infection syptomatic b2
• Hiv lipatrophy
• Hiv related cognitive impairment
• Hiv related non hodgkins lymphoma
• Hiv infection , symptomatic  
• Human immunodeificency virus myelitis
• lipoatrophy due to HIV infection and treatment
• Myelitis due to Hiv
• Nephropathy due to hiv
• Neuropathy due to human immunodeficiency virus
• Non hodgkin lymphoma associated with hiv infection
• polyneuropathy associated with aids
• postpartum aids
• symptomatic hiv infection category b1
• symptomatoc hiv infection category b2
• symptomatic hiv  infection  

Clinical Information ,

• A disease caused by human immunodeficiency virus , people with HIV has more prone to cause Acquired immunodeficiency syndrome and that are at an increased risk for developing a certain cancers and for the infections that usually occur only in individual with a week immune systems .
• A prodermal phase of infection of infection with the human immunodeficiency virus . The laborartory criteria separating aids - related complex (arc) from aids include elevated or hyperactive b- cell humoral immune responses , compared to depressed or normal antibody reactivity in aids , follicular or mixed hyperplasia in arc lymph nodes , leading to lymphocytes degeneration and depletion more typicals of aids , evolving succession of histopathological lesion such as localization of kaposi sarcoma .
• A syndrome resulting from the  acquired deficiency of cellular immunity caused by the human immuno deficiency virus . It is characterized by the reduction of the helper T- lymphocytes in teh peripheral blood and the lymph nodes , symptoms includes generalized lymphadenopathy , fever , weight loss and chronic diarrhea . patient with HIV are especially susceptible to opportunistic infections as like tuberculosis and the development of malignant neoplasma ( usually non- hodgkin's lymphoma and kaposi sarcoma . The HIV virus is transmitted through sexual contact , by sharing of contaminated needles or transfusion of contaminated blood .
• An acquired defect of cellular immunity associated with infection by the human immunodeficiency virus , a CD-4 positive T- lymphocytes count under 200 cells/ microliter or less than 14 % of total lymphocytes and increased susceptibilty to opportunistics infection and malignant neoplasm , clinical manifestation also include emaciation ( wasting ) and dementia . Also the tuberculosis That includes the tubercle bacilli found in sputum on laborartory examination .
• Teh state of infection accompained by evidence of HIV in the body ( positive test for HIV genome , C-DNA , proteins ,a ntigens or antibodies ) may be medically asymptomatic or symptomatic .
• Includes the spectrumn of human immunodeficiency virus infection that range from asymptomatic seropositivity ,
• One or more indicator dsiease , that depending on laborartory evidence of HIV infection , late phase Of HIV characterized by thw marked suppression of immune function resulting in opportunistic infections - tuberculosis ,

ICD 10 CM POa is grouped within diagnostic related group ( MS -DRG )

• Hiv with extensive o.r. procedure mcc
• Hic with extensive o.r. procedure without mcc
• Hiv with major related condition with mcc
• Hiv with major related condition with cc
• Hiv with major related condition without cc/mcc
• hiv with major related condition with mcc
• Hiv with major related condition with cc
• Hiv with major related condition without cc/mcc.

.

MCC	CC	DRG
yes	n/a	974
no	yes	975

no

no

976

DRG 974 HIV WITH MAJOR RELATED CONDITION WITH MCC
DRG 975 HIV WITH MAJOR RELATED CONDITION WITH CC
DRG (&^ HIV WITH MAJOR RELATED CONDITION WITHOUT CC/ MCC

Principal or secondary diagnosis of hiv infection

B20   Human immunodeficiency virus disease

AND

Pincipal or secondary diagnosis of major related condition

A150 Tuberculosis of lung

A154 Tuberculosis of intrathoracic lymph nodes

A155 Tuberculosis of larynx , trachea , bronchus

A156 Tuberculosis pleurisy

A157 Primary respiratory tuberculosis

A158 other respiratory tuberculosis

A159 Respiratory tuberculosis unspecified

A1801 Tuberculosis arthritis of other joints

A1803 Tuberculosis of other bones

A1809 Other musculoskeletal tuberculosis

A1810 Tuberculosis of genitourinary system , unspecified

A1811 Tuberculosis of kidney and ureter

A1812 Tuberculosis of bladder

A1813 Tuberculosis of other urinary organs

A184 Tuberculosis of prostate

A1815 Tuberculosis of other male genital organs

A1816 Tuberculosis of cervix

A187 Tuberculosis female pelvic inflammatory disease

A1818 Tuberculosis of other female geniatl organ

A182 Tuberculosis peripheral lymphadenopathy

A1831 Tuberculosis peritonitis

A1832 Tuberculosi enteritis

A1839 Retroperitoneal tuberculosis