[Music] ch ch [Music] [Music] [Music] ch [Music] [Music] oh [Music] [Music] we are going to talk about those guidelines and how to apply them so let's begin with HIV HIV is the acronym for human imuno deficiency virus all right so what is HIV what is it well it's a virus that attacks cells that helps the body fight infection and there's no cure but it is treatable with medicine and it can even be undetectable that's great advancement right all right so let's take a quick review of the guidelines and some of you might be saying hey I kind of know these guidelines I know but the more we do it the more repetitive we are the more we'll know it right yeah all right so here are the key guidelines B20 HIV AIDS once assigned once a patient has HIV AIDS or B20 the coder may never use any other HIV C code or HIV related code for this patient and when I'm saying HIV related code I'm talking about the ones that I'm about to show you all right also inconclusive laboratory evidence of HIV that's r75 contact withd and suspected exposure to HIV is z20.6 encounter for screening for HIV z11.4 HIV counseling when the counseling produced a negative result and the patient has no symptom then you assign z71.7 and when the patient has asymptomatic HIV this this computer is going by itself so I'm going to see if I can slow it down just a moment there you go all right so when a patient has asymptomatic HIV that means they have HIV but no symptoms without symptoms a symp symptomatic means without a means without symptomatic means means symptom 0 98.7 this is HIV disease complicating pregnancy childbirth and the perum and here are some things that you'll need to remember when you are sequencing HIV AIDS if the reason for the encounter or the RF is an HIV AIDS related condition then hi HIV AIDS is sequenced first it's not going to make sense it's not going to make as much sense as when you see it in an example and you will see it today and remember if the reason for the encounter is not related to HIV AIDS let's say the patient has HIV AIDS but the reason for the encounter is not related then you're going to sequence for that encounter first first followed by HIV AIDS now I don't know who that spoke to but hopefully somebody now I want to know what you know can you name these HIV codes all right so I want you to tell me what the code is when the patient has HIV AIDS it means that once they have HIV AIDS this code the coder may never use any other HIV related code for this patient what is this code that I'm talking about go ahead type your answer in the chat outstanding you all rocked it 100% of you said B20 look they even gave you a clock so you have time all right so I am going to slow up for the next one all right the next one is inconclusive laboratory evidence of HIV okay the patient came in they had a a Laboratory test the results are inconclusive which code do you assign look at that I'm going going put this little clock up here and I think you get a couple of seconds because I want everybody to respond and remember we will not divulge your answers anything you put in that chat is confidential so feel free we will not judge you remember we've been there before and this is why we don't have an open chat yes some people want that open chat but this is why all right the answer is r75 inconclusive laboratory evidence of HIV all right contact with and suspected exposure to HIV what is the code I'm going to put this clock up I love it I love it those answers are raining through let's say let's see all right so when a patient has been in contact with someone that has HIV any of these ways right here in the orange panel unprotected sex someone that has HIV High viral load yes someone diagnosed with a high viral load substance use douching multiple sexual partners so z20.6 so anytime they've been in contact with and suspected to um um exposure to HIV there you go all right next one encounter for screaming for HIV encounter for screaming that means the patient came in the door for screening and that's it there you go you all are rocking this chat rocking rocking rocking outstanding come on we have a few more people in here so we can get your answers good job good job that's what I'm talking about all right so the answer is z11.4 and last but certainly not least the patient has asymptomatic HIV that means they have a positive test result but no symptoms right and symptoms can be fever chills headaches night sweat sore throat muscle aches joint pain fatigue swollen lymph nodes mouth ulcers good job good job here you go and the answer is HOH boom z21 outstanding z21 category now all right so we got you going a little bit and know you don't have to memorize these the only one I think you should memorize B20 and z20 now are you ready to test your knowledge you ready for some scenarios I'm ready I love these because it lets me know how you're doing okay so this is how you solve a scenario number one you highlight or inventory your key terms in this case you're going to inventory your diagnoses signs and symptoms only only don't don't highlight your um procedures don't do that because um we're only talking about diagnosis when you move on to part three you're going to be expected to do all of these but for now highlight or inventory your keywords or key terms which will be your diagnosis signs and symptoms number two you identify that first listed code and three apply all guidelines this is a a general way to solve a scenario however however you're going to see us do multiple things just know whatever works for you is good it is best and we highly highly endorse it all right so now that we know how to solve a scenario there are some things that I want to tell you to always keep in mind make sure that you keep in mind these um category recognitions know that infectious diseases code range is a00 through b99 know that because we're talking about it right just thought I would just say that and the others too some of them may be applicable so keep that in mind it's going to help you solve scenarios quickly it will or more more efficiently and more quick you're going to have to you know you won't have to um look up every code because if this is a multiple choice um circumstance you're going to know you're going to be able to eliminate some wrong answers I promise all right also to remember don't forget this RF chart no we're not going to do all of these um columns but I want you to pay attention to the signs and symptoms remember they can be coded and they can be first listed when no diagnosis is present and remember do not code signs and symptoms integral or clinically related to a diagnosis in your inventory just saying now I'm ready for that first scenario you ready okay so because you know I've told you to make sure you pay attention to these um categories on site and also pay attention to that um first listed um code chart when it comes to signs and symptoms and the reason is because we tell you to read the first the last sentence first and the answers so I'm going to do that and when you're reading those answers process it which of the following icd1 M codes best described this scenario a z21 you should know what z21 is 0 98. 712 B 024 414 098 711 z21 Z3 a16 C 02 4.41 0 098 712 z21 Z3 A.1 6 and D 02 4.41 Z excuse me B20 98. 712 and Z3 a16 a 32-year-old pregnant female patient presents today for a routine 16-week follow-up visit to monitor her gestational diabetes controlled with diet she is HIV positive and her lab results have been within normal limits she has remained asymptomatic throughout her pregnancy which of the following icd10 CM codes best describes this scenario all right coders you have two minutes to solve and your time begins now I all right I see a lot of wonderful answers here in the chat and I just want to go ahead and get started by highlighting our key words all right we have a pregnant female patient 16 weeks 16 week follow-up visit this patient has gestation diabetes and this diabetes is controlled with diet she is HIV positive but her lab results have been within normal limits and she is she has remained asymptomatic throughout her pregnancy all right so hopefully these are your keywords and I want to inventory because this inventory inventory thing is really going to prove helpful all right so we have a pregnant female 16 weeks gestation gestational diabetes if you didn't know gestational diabetes is caused by the pregnancy just thought I would tell you that and this gestational diabetes is controlled with diet that means they're not giving this patient any medication or any insulin she is HIV positive but she's also asymptomatic so with that said is there anything that we can eliminate on site go ahead type your answer in the chat and if you can say why okay someone said we're eliminating a because it has two codes H all right and somebody said hey one of them is out of order yeah I think we can eliminate two on site but great job great answers well how I know we can eliminate something on site I go right to the guidelines I went to the guideline HIV disease complicating pregnancy right so when a patient has HIV and they're also pregnant there is the guideline guideline C1 A2 G and what I'm going to focus on is this third column it says chapter 15 codes always take sequencing priority in other words chapter 15 codes are going to be sequenced before the HIV code so if that's what you were saying why a needs to be eliminated eliminated outstanding your spot on all right also above this green box it tells you how it should be sequenced it's saying first 0 98.7 second B20 or z21 and third if the patient has an HIV related Condition it's going to be third all right so let's go ahead and eliminate a because chapter 15 codes always take precedence and that means chapter 15 are obstetrical codes and obstetrical codes begin with the letter o I'mma let that marinade and that is why knowing the categories on site can help you eliminate wrong answers and help you save time on your exam now let's finish up here you guys already a lot of you got this correct I'm going tell you that but I just want to have a little conversation with you and I hope you don't mind now let's look at b c and d and we're going to begin with our HIV and the documentation says hey this patient has no symptoms they are asymptomatic so the asymptomatic code is z21 right right and any answer that has B20 in it HIV AIDS is wrong so we can eliminate something else yeah someone said D all right so let's go ahead and get rid of D now let's turn our attention to the instructional note underneath z21 it said code first the human imuno deficiency virus disease complicating pregnancy 0987 all right so that already tells us that a is wrong because they are not coding it first and so too is d d is wrong because it's coding for the um B20 HIV AIDS now let's turn our attention to B and C and we need to determine what is the difference between B and C all right B is coding for O2 4.41 4 and C is coding for o24 410 Z so I'm going to look it up an O2 4.4 subcategory is for gestational diabetes militis so they're both correct they're both in the correct subcategory but if we go down to 0244 one0 code and 0244 one4 code o0 is coding for gestational diabetes malades and pregnancy diet controlled 14 is coding for insulin controlled and if you remember our documentation it says it's controlled with diet so 0244 410 is correct and four is incorrect and that leaves us with C now I'm not finished because let's do our due diligence and I want you to see the importance of reading and how these instructional notes will really help you in the HIV section 0 98.7 this is HIV disease complicating pregnancy child birth in a perum and these instructional notes underneath says use additional code to identify the type of HIV disease anytime you're instructed to use an additional code that means sequence second or subsequently so when we say that the HIV comes after 0 98.7 it does it does indeed and that's what that means but if you look at C you see the gestational diabetes sequence first next you see the HIV disease complicating pregnancy second and then after that as long as it's subsequent to 98.7 your HIV should come next all right so the um gestational diabetes is her first listed code and we also coded the week's gestation Z3 a16 and she's 16 weeks and if you if you need to know um the trimesters is in your um manual in chapter 15 your first trimester is less than 14 weeks second trimester is 14 weeks zero days up to or less than 28 weeks and third trimester is 28 weeks until delivery all right coders I know I was kind of long on that one but there were some points that I wanted to make and I won't repeat them I think you got it you all you knocked it out the park everybody good good deal good deal somebody said they're doing this without the book OMG and you know what you're going to be able to solve these scenarios a lot of them without the book that's my goal that is my goal all right so if you said c outstanding let's continue what icd10 CM codes should be reported a B20 f19 f41.9 I 10 b f41.9 z21 c f41.9 db20 r06.02 f 53.83 i 10 a 35-year-old male was admitted due to increased shortness of breath and fatigue with possible diagnosis of HIV understandably this has caused the patient to become anxious and his blood pressure was elevated today at 140 over 88 the patient was started on an excuse me Xanax for anxiety lowf flow oxygen and ni IV all right coders your time begins now all right so I see some discussions in the chat you all are rocking it okay now our key words shortness of breath fatigue possible diagnosis of HIV anxious blood pressure elevated started on Xanax for anxiety these are my inventory shortness of breath fatigue possible HIV anxious elevated blood pressure anxiety now I have a question for you coders you to tell me in the inventory which of the inventory can be eliminated or which of the inventory is related to a diagnosis on that inventory sheet or List talk to me in the chat which can you eliminate okay I'll just say this can we eliminate shortness of breath yes shortness of breath is related or an indicator of anxiety right yeah anxiety is a diagnosis on here and we discussed um you know main terms versus um diagnosis signs and symptoms so let's really just identify what the diagnoses are okay or diagnosis or diagnoses well anxiety is a diagnosis and let's say possible HIV is a diagnosis so is shortness of breath related to anxiety or possible HIV yes what about fatigue is that a clinical indicator related to anxiety or possible HIV yes people with anxiety sometimes hyperventilate yes what about anxiousness is that a clinical indicator of anxiety yes we're going to get rid of you and what about elevated blood pressure is that a clinical indicator or related to HIV or anxiety yeah yeah somebody call me a dad okay yeah I'll take it I'll take it yes it is and you know what just so you know this elevated blood pressure is not high blood pressure if it's temporary or episodic a specif specific event that's causing it your doctor has to diagnose you with HIV excuse me high blood pressure and that didn't happen in this encounter so I only have two diagnoses that's it and that's pretty much what we're going to be coding for but I'm still going to go and check out my guideline there's a guideline for HIV infection illness guidelin C1 A1 and over in the right hand column it says code only confirmed cases the provider's documentation is enough without a serology or other testing however it must be confirmed all right coders do you see any language of confirmation of HIV in this documentation no I do not either we just see possible diagnosis of HIV so you know what that means we eliminate HIV from every answer and we're going to eliminate it from a D and B all eliminated the patient is not diagnosed are you with me so let's go ahead and the answer is C anxiety oh I'm not finished we got to do our due diligence but hopefully you understood that good deal somebody said they're with me outstanding all right so let's go ahead and let's look up these codes we know this patient had possible diagnosis of HIV so they do not have it they don't have B20 they don't have a21 also I 10 this is the code for essential hypertension this includes high blood pressure not elevated elevated blood pressure is not the same okay just want let me put it back so you can say so this was situational and not high blood pressure or htn diagnosed by The Physician so we can't code it here is our inventory just want you to be mindful of that R 6.9 is dipsia we're not coding it because it's integral to anxiety fatigue we aren't coding it because it's also integral to anxiety But anxiety disorder we will code it and our answer is C how you doing coders if you got that correct outstanding all right I see hearts in the chat someone said they're good someone said said that was a good one that's what I love to hear let me know talk to me all right what are the appropriate icd1 CM codes for this encounter a B20 j30.2 b j30.2 z21 c j30.2 B20 and D B20 r09.81 r5. n Jane is a 45-year-old AIDS patient who has been stable with low viral load for over 10 years she presents to the clinic today complaining of sore throat and increased cough and nasal congestion her vitals are stable and her blood work is normal a strep screen is negative her provider prescribed an antihistamine for seasonal allergies okay coders your time begins now for I think I my clock just stopped so I am going to continue if you don't mind all right so here are my key terms AIDS patient sore throat increased cough nasal congestion this patient was prescribed an antihistamine for seasonal allergies here's my inventory AIDS patient sore throat increased cough nasal congestion seasonal allergies all right coders question what are my two diagnoses we have two diagnoses in this inventory list and then we're going to see if these signs and symptoms are integral to them if they are we're not going to code them if they're not we will code them all right what are my two diagnosis there you go people we saying AIDS patient and seasonal allergies or one in five outstanding outstanding all right so is sore throat related to AIDS or seasonal allergies it doesn't matter as long as it's related to one we're going to eliminate it should we eliminate sore throat go ahead type your answers in the chat yes sore throat is related to seasonal allergies we do know that increased cough I think it's related to seasonal allergies and nasal congestion yep seasonal allergies so we're going to eliminate these three and you know I'm going to go see if there's a guideline that's applicable and there is because we have an admission for a nonrelated condition right so when the admission is not relate is not for an HIV related condition you have to sequence the reason for the encounter first followed by the HIV aids code I'm certain based upon the uniform Hospital discharge data set chart that purple chart that the reason for the encounter is the allergies because the allergies was chiefly treated she was prescribed an anti-histamine nothing was done for her HIV AIDS her AIDS nothing so I'm going to say seasonal allergies is the chief RF so coders knowing that you can eliminate or get the answer right on site some of you got it correct on you know at the onset but if you said another answer based on what I've just said go ahead change your answer if you'd like yes I see people changing answers or given the same answer they gave the first time outstanding yes we can eliminate B I mean a because B20 is being sequenced first the guidance in the green box says hey you sequence RF first and the RF is seasonal allergies so we're getting rid of a and we're going to get rid of D for the same reason and we're also getting rid of D because they are coding signs and symptoms our documentation also says that this is an AIDS patient if this is an AIDS patient this means that they have AIDS they are not asymptomatic they have AIDS all right when a patient has been classified as AIDS they are at the final stage of AIDS yes it's the final stage so there is no way they can be HIV um excuse me asymptomatic no way hopefully that makes sense all right so I'm going to continue even though we can eliminate these you know the wrong answers on site I'm still going to do my due diligence and we're going to look up these codes not from the index but from the tabular list right yeah and also too we know that this J code is a respiratory code right seasonal allergies is in the respiratory system I'm just saying all right so let's go ahead and let's do our due diligence remember the sequencing order when an admission is not for an HIV related condition sequence the RF so we've gotten of A and D because of the human um defici you know the B20 is is um not the reason for the encounter and we're we've gotten rid of D nasal congestion and cough because this is integral to the allergies and they're not even coding for the allergies of deep so you got to go too so just so you know the Astic asymptomatic um HIV is not correct because this patient does have AIDS gotta go and let's look at C J30 vasom motor and allergic R ritis and if you look below j30.2 other seasonal allergic ritis is the correct answer all right so if you have questions type them in the chat if you got it correct outstanding but if you understood and changed your answer that is priceless okay coders I got another one oh look unse that sorry about that I should switch these up but I don't want to do that it take too long I apologize for that let me uh check and make sure that doesn't happen again all right so this is going to be a good um this GNA be a teachable moment all right of the following which icd1 CM codes best describes this encounter a B20 B 37.9 b b 37.9 9 B20 C B3 7.9 z21 and d z21 b37 n a 35-year-old male patient who is known to be HIV positive and asymptomatic presents to the Ed complaining of oral pain and extreme discomfort he reports having white patches in his mouth along with sores a physical exam reveals signs of candid diasis following a positive culture the patient was diagnosed with thrush The Physician prescribed NY Statin Swish and swallow to treat the candid diasis of the following which ICD TCM codes best describe this encounter and we should have 100% of you say the answer yeah sorry about that everybody good deal somebody said hey I would have got that even if you didn't show me the answer that person is a person who study their guidelines yep it's your guidelines that's going to drive your answer all right I'm going to just move forward since I just spoiled it for everyone and I do apologize my key words HIV positive and asymptomatic oral pain extreme discomfort patches white patches in mouth soreness signs of candid diasis thrush candidasis in my inventory is such HIV positive asymptomatic oral pain um extreme discomfort white mouth patches soreness signs of candidasis and thrush and finally candidasis all right coders list the diagnoses that we should keep list all of the diagnoses in the chat let me see what you're saying that's right somebody said one two and eight okay wait a minute here we go somebody said one two eight H could be all right somebody said one and nine somebody said one 2 N okay well what about oral pain we know oral pain is related to both thrush and candid diasis right so you got to go extreme discomfort can be related to being HIV positive but maybe not asymptomatic right white mouth patches yeah thrush candidasis soreness thrush candidasis signs of candidasis is related is a clinical indicator of C dasis right and thrush is related to candidasis I think over growth of thrush can cause candidasis all right so this patient is HIV positive and asymptomatic doesn't seem like he's he's asymptomatic anymore right no all these symptoms all right so let's go ahead and let's see if there's a guideline and there is when the admission is for an HIV related condition you're going to sequence it as such you're going to sequence first B20 followed by that HIV related condition and then you might say well I don't know what HIV related condition is you may not but they are the common HIV related conditions are listed in your MCG manual right so we have HIV it say common HIV related conditions here you have kosi saroma lioma pumos cytis cystitis Kini pneumonia or PCP crypto coo menitis cyto Megalo virus or CMV toxoplasmosis tuberculosis and thrush thrush is an HIV a common HIV related condition and candidasis is a um overgrowth of candada or thrush it's a type of fungus all right now coders anytime you have an HIV symptoms you are no longer asymptomatic I'm going to let that marinate anytime you have HIV symptoms you are no longer asymptomatic so we can eliminate some answers on site type in the chat coders I want everyone to type the answer in the chat based upon what I just said right somebody said we can get rid of a you can get rid of a based on look at the green box it's telling you how to sequence it you can get rid of B because the green box is telling you how to sequence it and B is excuse me you can get excuse me you can keep a my apology thank you so much everyone you can keep a because the box is telling you how to sequence it and a is sequencing it accordingly B is sequencing it incorrectly see B20 followed by the HIV related condition C you can get rid of because you're coding for an a symptomatic circumstance and this patient is now symptomatic and so too is D and the answer is a that's right somebody said b c d Gotta Go Gotta Go and that's right a is the answer and that's how if you know the guidelines you'll be able to solve a lot of these questions on your exam very quickly now let's go ahead and do it the long way all right so remember the sequencing order B20 followed by your HIV related condition we know this patient was diagnosed with candid diasis they had thrush and thrush is an HIV related condition so um the patient is HIV positive but the documentation says they're asymptomatic upon um arrival however all of these symptoms make them no longer asymptomatic so any code any answer with z21 in it is incorrect so C and D gotta go and your human um if imuno deficiency virus HIV there's an instructional note underneath it tells you to code additional codes to identify all manifestations of HIV in other words all HIV related conditions and again when I told you earlier when your instructional note says use an additional code that means you're going to sequence it subsequently you're going to sequence it after that [Music] B20 and notice z21 does not have that note it can't have that note because if a patient has manifestations of HIV then it's no longer asymptomatic it is symptomatic all right so our guidance tells us the sequence first B20 followed by the HIV related condition and if we go down to candid diasis b37.3 and B is sequenced incorrectly a is our answer and if you got that right outstanding but if you had an aha moment that is priceless how are you coders I [Music] got I have one more then I have a little challenge somebody said they're great two people said I'm great somebody said I'm loving it somebody said wonderful good let's see how many people we have in here and if you're lost say I'm lost it's okay I'm not going to judge you the only thing I'm going to say is definitely take um time to watch the playback and if you didn't do the homework you may be a little lost but go ahead and do the homework it's not too late all right so now I mean you know knowledge is everything maybe you didn't know that it required this kind of attention because it's different than part one it's all right all right so we got another scenario you're good everybody is good you're fine with me which of the following codes best describes the encounter a 0 98. 712 z21 B 37.0 [Music] b2441 0 098 712 z21 C 098 713 B20 and b 37.0 d B20 98. 713 B 37.0 a 32-year-old pregnant female patient HIV positive who is 30 weeks pregnant presents to her PCP with the complaint of loss of taste and burning and painful burning sensation in her mouth her PCP suspects possible covid-19 or strepped throat both rapid strep and covid tests are negative upon physical examination The Physician notes cracking around the corners of the patient's mouth on oral exam her PCP also notes white plaques on the patient's tongue which bled when scraped with the tongue depressor the patient was diagnosed with thrush and prescribed n stat and Swish and swallow which of the following best describes the encounter all right your time begins now I think you all are rocking yeah this one is similar but I think um the repetition is good okay here are my keywords HIV positive 30 weeks pregnant loss of taste painful burning s sensation in her mouth the PCP suspects covid-19 or strep throat the strep test and covid tests are negative cracking around the corners of the mouth white plaques on the patient's tongue which bled diagnosed with thrush here's my inventory okay coders what are the diagnoses in this on this list go ahead type your answers in the chat yes HIV positive 30 weeks pregnant and thrush absolutely one 2 N outstanding all right so what about loss of taste yeah it's related to thrush or maybe HIV I don't know painful burning H could be thrush right or HIV suspect covid well it's not confirmed so you got to go suspect thrush it's not confirmed you're going to go to cracking around the mouth that could be related to thrush the tongue the white tongue and um the white tongue plaque and bleeding of the tongue that's related to thrush too so one two n are that's what we have to deal with now do we have a guideline all right let's go check out a guideline let's check out the guidelines and see if anything is applicable but I want you to tell me which guideline would you use which guideline would you reference anybody know you don't have to be specific but what is look at this somebody putting the dog on guidelines out [Applause] outstanding yeah yeah I would reference a guideline about a pregnant patient with HIV I would go right to the guideline right so let's pull it up somebody even had the number outstanding C1 a. 2G it's says chapter 15 codes always have sequencing priority look at d d was trying to sequence that B that HIV code so we're going to let it go so that's a good one now let's go ahead and do our due diligence oh also too look how they're sequencing 98.7 followed by B20 or z21 and then your HIV related condition in that order is anybody doing that okay all right there's the sequencing order and here's our guideline and this z21 is for asymptomatic HIV we just said when a patient has symptoms they're no longer asymptomatic so a b got to go also this patient has gestational diabetes that's what it says in the um no the patient doesn't have excuse me code B option b is coding for gestational diabetes and this patient does not have gestational diabetes at all so we're going to get rid of A and B so B is wrong for multiple reasons A and B are wrong because they're coding for asymptomatic conditions now if we go up to B20 the HIV guidance it tells you to code first your um 98.7 and and then use all additional codes to identify the manifestations right we're going to eliminate D because D is coding for B2 first we already said that right so that's why we're eliminating D and C is our answer now let's go ahead and look at the um answers here at 098.0 09 it it there's guidance to it tells you to use additional codes additional means sequence after me sequence after 0987 and we did right we're going to sequence B20 after 098 713 but let's look down 098 713 this is human imuno deficiency virus HIV disease complicating pregnancy in the third trimester all right so somebody said hey why didn't we put the week's gestation sometimes you're not going to see it when you have a code that integrates the trimester sometimes all right just saying so when you have that on your exam don't get flustered right okay so the answer is C and if you got that correct outstanding oh don't forget the candidasis B3 7.0 all right so we got a flip challenge yes this is I believe one of the scenarios in one second I hope so one second I think I have a little bit of a yeah I think this is one of the questions and it's a little more difficult you all ready yeah you don't see any an you don't see any multiple choice yeah we've practiced so much that at least you can kind of figure out you can put be in the ballpark all right so code the encounter Peggy has been HIV positive for 5 years she's now 20 weeks pregnant she arrived at the Ed with labored breathing after tests she is diagnosed with AIDS with pneumocystis karini pneumonia ECP all right coders I'm going to give you I think this is 2 minutes your time begins now yes this one is a little more it took a little more time so I don't expect you to have looked up everything okay all right first things first let's go ahead and highlight our key terms HIV positive 28 weeks pregnant um diagnosed with AIDS with pneumocystis Kini pneumonia all right coders do you all remember me saying that um the common HIV related conditions yeah um the numos cystitis Kini pneumonia is PCP for short so make sure that you remember that it is an HIV related condition so here is my inventory HIV positive 20 weeks pregnant aids with numos cystitis Kini pneumonia all right so let's go ahead I'm pulling up just an abbreviated guideline for HIV in pregnancy complicating pregnancy and I'm looking at this third column is telling you to sequence as such 0 98.7 and B20 followed by B20 and then the HIV related condition this is HIV related um disease complicating pregnancy with AIDS related conditions all right so let's go ahead and let's see how we look it up you look up pregnancy Complicated by HIV and it tells you to go to 09871 and we're going to go to the category 098 in the tabular list and this is for maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy childbirth and the perum and it includes the listed conditions when complicating the pregnant State when aggravated by the pregnancy or as a reason for obstetrical care and then I'm going to go down and it says or and read this instructional note and it says use additional code from chapter one to identify specific infectious or parasitic disease man if we just read it will guide us all the way now let's keep going down the path until we get to our subcategory 0987 human imuno deficiency virus HIV this is correct and then it tells us use additional codes for the HIV then we go down further and we're going to look for our trimester our patient is 20 weeks pregnant so um 28 weeks excuse me 28 weeks is the third trimester and I'm going here and I'm going to locate 09871 3 HIV in the third trimester so I think we got some answers here and we also know this patient has PCP with AIDS so we can kind of code some right we know our first first code is O not zero Mrs j o one second okay I want to fix it you know some people are very visual they might say hey that o threw me off and I understand Ain tight I can't do it it's not letting me okay okay I'm back oh no I'm really not back one second I'm I'm just showing too much here we go now I'm back all right so here we go now we know our um instructional note told us to code Additionally the HIV aids and that we are doing because she has AIDS related complications so it is B20 and it's telling you how to sequence you're going to sequence the 0 98.7 followed by the B20 and then we're going to use additional codes to code all manifestations of the HIV infection which is um PCP num numos ctis karini HIV all right b59 and I'm going to put the week's gestation I am even though it's in the first code the um trimester because that's how it should be done all right coders did you all see how reading can get you to the answer M yeah all right so now let me give you a little bit of tap while I can and then Mr Sandeep will be up next all right so if you had a situation let's say on your exam you have a multiple choice circumstance right then let's say you want to you know I'm just show you this is where the guideline is guideline G this is where I get the guidance for the MCG right here and this is where I am going to place my sequencing right at the guideline and I'm also going to place my sequencing in the tabular list and this is where I'm tapping I'm going to write the word tap because I want to draw attention to the fact that I have sequencing order right there I'm placing the sequencing order so that if I have this question on the exam I'm going to be able to quickly identify it I'mma let that marinade so that is why it's important to tap one of the reasons why it's important because if you look we have four answers and D matches your TAP best all right so someone said they're confused please um be specific I'm going to try and answer you and while you're doing that being specific in the chat Mr sand deep please and thank you thanks for tuning in and until next time happy [Music] coding