HIV CODING Guidelines

The Unconventional Guide to HIV Coding Guidelines

Do you know there are plenty of articles are related to ICD 10 Guidelines and HIV Coding guidelines that are just less informative and very random doesn’t even provide useful information at all related to ICD 10 Guidelines 2021 and HIV Coding guidelines 2021

 By reading the Headline  “ The Unconventional Guide to HIV Coding Guidelines

“ you might also think that this Is one of the most randomized and not even helpful post,

If you made a conclusion like this! I have to tell you a word “ This is Not a Random post “, This my research towards ICD 10 Guidelines,  I am writing this post to make you realize the easiness of the HIV Coding Guidelines with examples and every one should become master in HIV Coding guidelines

What is ICD :

ICD Stands for International classification of diseases

ICD 10 Guidelines mainly depends upon conventions and chapter wise guidelines

HIV Coding Guidelines  :

These guidelines belongs to the Chapter one ICD Guidelines i.e certain infectious and parasitic diseases, before discussing about the HIV Coding guidelines lets try to understand what is HIV

What is HIV infection :

HIV Coding guidelines

HIV is a virus that attacks immune cells and making a person weak and  causing more  infections diseases.

It is spread by contact to body fluids and unprotected sex or injection sharing

The virus can be transmitted through contact with infected blood, semen and  vaginal fluids.

After  a few weeks of HIV infection symptoms like fever, sore throat and fatigue can occur

HIV Phase is  usually asymptomatic until it reaches the stage AIDS. AIDS symptoms include weight loss, fever, night sweats, fatigue and recurrent infections.

There is No cure  for AIDS, but using antiretroviral regimens can dramatically slow the disease’s progress as well as prevent secondary infections and complications.

HIV Coding guidelines scenarios :

ICD 10 Guidelines

a) Human Immunodeficiency Virus (HIV) Infections :-

Code HIV infection diagnosis only in confirmed cases

We have to code HIV in only confirmed cases, “confirmation” does not require documentation of positive serology or culture for HIV

The provider statement as patient is “ HIV positive “ or patient has “ HIV-related illness “ is sufficient

Eg : Patient being seen for hypothyroidism with possible HIV infection

Here we should code hypothyroidism only because provider is saying that HIV as possible

Hence we shouldn’t code HIV infection

Sequence would be : E03.9  Hypothyroidism unspecified

Selection and sequencing of HIV codes : 

a) Patient admitted for HIV-related condition :

When a patient is admitting with HIV related condition the first listed diagnosis should be  

B20 – Human immunodeficiency virus [HIV] disease followed by additional diagnosis for all the symptoms

Eg : patient comes with HIV with Cytomegaloviral disease 

Cytomegaloviral disease is an HIV related condition , so here HIV disease code should be report

first followed by Cytomegaloviral disease

Sequence would be like this B20, B25.9 

  B20   Human immunodeficiency virus [HIV] disease

 B25.9  Cytomegaloviral disease, unspecified

Opportunistic infections : Opportunistic infections (OIs) are infections that occur more frequently and are more severe in people with weakened immune systems, including people with HIV. 

Candidiasis of bronchi, trachea, oesophagus, or lungs

Invasive cervical cancer



Cryptosporidiosis, chronic intestinal (greater than one month’s duration)

Cytomegalovirus diseases (particularly retinitis) (CMV)

Encephalopathy, HIV-related

Herpes simplex (HSV): chronic ulcer(s) (greater than one month’s duration); or bronchitis, pneumonitis, or esophagitis


Isosporiasis, chronic intestinal (greater than one month’s duration)

Kaposi’s sarcoma (KS)

Lymphoma, multiple forms

Tuberculosis (TB)

Mycobacterium avium complex (MAC) or Mycobacterium kansasii, disseminated or extrapulmonary. Other Mycobacterium, disseminated or extrapulmonary.

Pneumocystis carinii pneumonia (PCP)

Pneumonia, recurrent

Progressive multifocal leukoencephalopathy

Salmonella septicaemia, recurrent

Toxoplasmosis of brain

Wasting syndrome due to HIV

b) Patient with HIV disease admitted for unrelated condition :

When a patient having HIV Disease and is admitted for unrelated condition ( Injury )

That unrelated condition  should coded as primary diagnosis followed by HIV disease then HIV related conditions

Eg : Patient admitted for  Sprain of the internal collateral ligament, right ankle and patient already diagnosis with HIV disease

Here the patient is admitting for the unrelated condition to HIV disease, Hence that unrelatd condition should be coded as primary diagnosis

Sequence would be like this : S93.491A, B20

S93.491A  Sprain of other ligament of right ankle, initial encounter

B20         Human immunodeficiency virus [HIV] disease

c) Whether the patient is newly diagnosed :

Whether the patient is newly diagnosed or has had previous admissions/encounters for

HIV conditions is irrelevant to the sequencing decision

Eg : Newly diagnosed multiple cutaneous Kaposi’s sarcoma lesions in previously diagnosed HIV disease

Sequence would be like this :  B20, C46.0

Even though the HIV was diagnosed on a previous encounter, We have to code HIV disease

first because Kaposi’s sarcoma is an HIV-related condition.

B20      Human immunodeficiency virus [HIV] disease

C46.0    Kaposi’s sarcoma of skin

d) Asymptomatic human immunodeficiency virus :

Z21 Asymptomatic human immunodeficiency virus [HIV] infection status code is used when there is no documentation of HIV related symptoms or documented as HIV Positive, known HIV, HIV test positive

Do not use this code –Z21 when there is clear documentation of AIDS /HIV disease/HIV Symptomatic

For these cases we have to use B20

Eg : Patient is treated for iron deficiency anemia. Status positive HIV test on Atripla, with no prior symptoms

anemia is not an HIV-related complication and is sequenced first

Sequence would be like this : D50.9,Z21

D50.9  Iron deficiency anemia, unspecified

Z21    Asymptomatic human immunodeficiency virus [HIV] infection status

g) HIV Infection in Pregnancy, Childbirth and the Puerperium :

During pregnancy, childbirth or the puerperium, a patient admitted because of an HIV-related illness we should  code O98.7-, Human immunodeficiency [HIV] disease complicating pregnancy, childbirth and the puerperium as primary diagnosis followed by B20 and the code(s) for the HIV-related illness(es).

Codes from Chapter 15 always take sequencing priority (Pregnancy, Childbirth, and the Puerperium)

Sequence would be like this : O98.711,B20

O98.711 Human immunodeficiency virus [HIV] disease complicating pregnancy, first trimester

B20        Human immunodeficiency virus [HIV] disease

h) Encounters for testing for HIV  :

A patient is admitted to determine the  HIV status, use code Z11.4,

Z11.4  Encounter for screening for human immunodeficiency virus [HIV].

Use additional codes for any associated high risk behavior

a patient admitted  with signs or symptoms and is being seen for HIV testing, code the signs and symptoms.

An additional counseling code Z71.7, Human immunodeficiency virus [HIV] counseling, may be used if counseling is provided during the encounter for the test

When a patient returns to be informed of his/her HIV test results and the test result is negative, use code

Z71.7, Human immunodeficiency virus [HIV] counselling.

Z71.7  Human immunodeficiency virus [HIV] counselling

Z11.4  Encounter for screening for human immunodeficiency virus [HIV].

History of HIV managed by medication : 

If a patient with documented history of HIV disease is currently managed on antiretroviral medications, assign code B20, Human immunodeficiency virus [HIV] disease. Code Z79.899, Other long term (current) drug therapy, may be assigned as an additional code to identify the long-term (current) use of antiretroviral medications

Eg : 46 Years male patient has PMH of HIV Disease and now he is on antiretroviral medications for his HIV Disease

Here the patient is having PMH of HIV Disease and for this he is using antiretroviral medications, we should sequence AIDS as pdx followed by the long term drug threapy code

Sequence would be like this    B20, Z79.899

B20             AIDS

Z79.899      Other long term (current) drug therapy

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Commonly asked questions :

Is HIV always coded first?

No, based on the provider documentation and reason for the visit the sequence priority might be changes, if HIV meeting the criteria of primary diagnosis then only we should assign B20 or Z21

What is ICD 10 code for HIV Disease?

If you search in ICD 10 CM alphabetic index of diseases with the term disease under this you will find HIV after to this term you will find a code B20 and that is the code for HIV Diseases

What is the difference between B20 and Z21?

B20 is a code for HIV Symptomatic phase, Z21 is a code for HIV asymptomatic phase

Can we code HIV asymptomatic code i.e Z21 after the patient diagnosed with AIDS

No we shouldn’t code Z21 after the confirmation of AIDS

Conclusion :

We have understand the importance of ICD 10 Conventions and chapterwise ICD guidelines

We all learn how to code these scenarios

Patient admitted for HIV-related condition

Patient with HIV disease admitted for unrelated condition

Asymptomatic human immunodeficiency virus HIV Infection in Pregnancy, Childbirth and the Puerperium