225 When International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) is released, guidelines for reporting on certain infectious and parasitic diseases will be found in Chapter 1 of the tabular list (codes A00–B99). This article will provide an overview of those guidelines (with the exception of guidelines for reporting sepsis, which was reviewed in the November 2014 AAP Pediatric Coding Newsletter™). For this and other articles in the “Transitioning to 10” series, please see the Transitioning to 10 collection at http://coding.solutions.aap.org/transitioning.aspx. HIV Infections Code B20, HIV disease, is reported as follows: ■■ Report B20 only for cases confirmed by a physician’s statement that the patient has symptomatic HIV, an HIV-related illness, or history of an HIV-related illness. ■■ Inconclusive laboratory evidence of HIV is reported with code R75. ■■ Report first the code for HIV (B20) when the reason for the encounter is an HIV- related condition. Related conditions are additionally reported. When an encounter for a patient with HIV disease is for unrelated conditions, report first the condition most responsible for the encounter followed by the code for HIV disease. ■■ Encounters for patients who are HIV-positive but without symptoms or documenta- tion of any HIV-related condition or history of an HIV-related condition are reported using code Z21, asymptomatic HIV infection status, rather than code B20. Code Z11.4 is appropriate for reporting an encounter for screening for HIV. Additional codes identifying high-risk behavior may also be assigned. Counseling about HIV in the absence of a positive HIV result is reported with code Z71.7. For patients with a positive HIV result, report code Z21 or, if symptomatic, code B20. Infectious Agents as the Cause of Diseases Classified to Other Chapters Categories B95–B97 are used to report an identified infectious agent when a disease is classified in chapters other than Chapter 1 of the tabular list and the code descriptor does not include the infectious agent. An instruction at the code for the condition will typically instruct to also code any known infectious agent. Example A child has a urinary tract infection with Escherichia coli identified as the infectious agent. The code for the urinary tract infection is listed first, followed by the code identifying the infectious agent. N39.0 Urinary tract infection, site not specified B96.20 Unspecified Escherichia coli [E coli] as the cause of diseases classified elsewhere Appendix B-1 Infection (continued on page 226)
Previous Page Next Page