HIV Coding Guidelines

talk about those guidelines and how to apply them. So let's begin with HIV. HIV is the acronym for Human Immunodeficiency 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 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 with 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 symptomatic means without. A means without. Symptomatic means symptom. 098.7. This is HIV disease complicating pregnancy, childbirth, and the purpureum. And here are some things that you'll need to remember. When you are seeking... sequencing HIV-AIDS, if the reason for the encounter or the RFE is an HIV-AIDS-related condition, then 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, followed by the reason for 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'm 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 laboratory test. The results are inconclusive. Which code do you assign? Look at that. I'm going to 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. Yeah, 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 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 the 20.6. So anytime they've been in contact with and suspected to exposure to HIV, there you go. All right, next one, encounter for screening for HIV. Encounter for screening. 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, boom, Z21. Outstanding. Z21 category. Now, all right, so we got you going a little bit. And no, you don't have to memorize these. The only one I think you should memorize, B20 and Z21. 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. Don't... Don't highlight your procedures. Don't do that. Because we're only talking about diagnoses. 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 diagnoses, signs, and symptoms. Number two, you identify that first listed code. And three, apply all guidelines. this is 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 ranges 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. look up every code because if this is a multiple choice 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 RFE chart. No, we're not going to do all of these columns, but I want you to pay attention to the signs and symptoms. Remember, they can be coded and they can be first listed with no diagnosis as 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 I've told you to make sure you pay attention to these categories on site and also pay attention to that first listed code chart when it comes to signs and symptoms. And the reason is because we tell you to read 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 ICD-10-CM codes best describes this scenario? A, Z21. You should know what Z21 is. 098.712. B, 024.414. 098.711. Z21. Z3A.16. C, 024.414. 098.712, Z21, Z3A.16, and D024.41. 0, 0, excuse me, B20, 098.712, and Z3A.16. 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 ICD-10-CM codes best describes this scenario? All right, coders, you have two minutes to solve, and your time begins now. 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 keywords. All right. We have a pregnant female patient. 16 week. 16 week follow up visit. This patient has gestational diabetes. And This diabetes is controlled with diet. She is HIV positive, but her lab results have been within normal limits. And she has remained asymptomatic throughout her pregnancy. All right. So hopefully these are your keywords. And I want an inventory because this inventory thing is really, 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. Somebody said we're eliminating A because it has two codes. Hmm. 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 C1A2G. And what I'm going to focus on is this third column. It says chapter 15. 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, outstanding, you're spot on. All right, also above this green box, it tells you how it should be sequenced. It's saying first, 098.7. 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'm going to let that marinate. 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 to 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 immunodeficiency virus disease complicating pregnancy, 098.7. 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 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 024.414 and c is coding for 024.410 so i'm going to look it up an 024.4 subcategory is for gestational diabetes mellitus so they're both correct they're both in the correct subcategory But if we go down to 024.410 code and 024.414 code, O0 is coding for gestational diabetes, malady, and pregnancy diet controlled. 14 is coding for insulin controlled. And if you remember our documentation, it says it's controlled with diet. So... 024.410 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. 098.7, this is HIV disease, complicating pregnancy, childbirth, and a purpureum. 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 098.7, 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 098.7 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, Z3A.16, and she's 16 weeks. And if you need to know, the trimesters is in your 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 ICD-10-CM codes should be reported? A, B20, F1.9, F4.1.9, I10. B, F4.1.9, Z21. C, F4.1.9, D, B20, R06.02, F53.83, I10. 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 Xanax for anxiety, low flow oxygen, and an 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 keywords. 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 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, you know, main terms versus diagnoses, 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 called me a dudette. 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 temporarily or episodic, a 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 gonna be coding for. But I'm still gonna go and check out my guideline. There's a guideline for HIV infection illness, guideline C1A1. 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 i10 this is the code for essential hypertension this includes high blood pressure not elevated elevated blood pressure is not the same okay i just want to 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 r06.9 is dipsnia 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 that was a good one That's what I love to hear. Let me know. Talk to me. All right. What are the appropriate ICD-10-CM codes for this encounter? A. B20, J30.2. B. J30.2, Z21. C. J30.2, B20. And D B20, R09.81, R05.9. Jane is a... 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. I think my clock just stopped. So I am going to continue, if you don't mind. All right, so here are my key terms. AIDS patients, 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 diagnoses? There you go. People are 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 non-related 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 antihistamine. nothing was done for her HIV AIDS, her AIDS, nothing. So I'm gonna say seasonal allergies is the chief RFE. 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 giving 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 rfe first and the rfe 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, 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 RFE. So we've gotten rid of A and D because of the human um deficient 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 d so you got to go to so just so you know the asymptotic asymptomatic hiv is not correct because this patient does have AIDS, got to go. And let's look at C, J30, vasomotor, and allergic rhinitis. And if you look below, J30.2, other seasonal, allergic rhinitis 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, unseat that. Sorry about that. I should switch these up, but I don't want to do that. It'd take too long. I apologize for that. Let me check and make sure that doesn't happen again. All right, so this is going to be a good, this is going to be a teachable moment. All right, of the following, which ICD-10-CM codes best describes this encounter? A, B20, B37.9, B, B37.9, B20, C, B37.9, Z21, and D Z21B37.9. 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 candidiasis. Following a positive culture, the patient was diagnosed with thrush. the physician prescribed nystatin swish and swallow to treat the candidiasis of the following which ICD-10-CM 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 studied 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 keywords hiv positive and asymptomatic oral pain extreme discomfort, patches, white patches in mouth, soreness, signs of candidiasis, thrush, candidiasis. In my inventory is such HIV positive, asymptomatic, oral pain, extreme discomfort, white mouth patches, soreness. signs of candidiasis and thrush and finally candidiasis. 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 hmm could be all right somebody said one and nine somebody said one two nine okay well what about oral pain we know oral pain is related to both thrush and candidiasis right so you gotta go Extreme discomfort can be related to being HIV positive, but maybe not asymptomatic, right? White mouth patches, yeah, thrush, candidiasis. Soreness, thrush, candidiasis. Signs of candidiasis is related, is a clinical indicator of candidiasis, right? And thrush. is related to candidiasis. I think overgrowth of thrush can cause candidiasis. All right. So this patient is HIV positive and asymptomatic. Doesn't seem like 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 an 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 says common HIV-related conditions here. You have Kaposi's sarcoma, lipoma, pneumocystitis, cystitis, carini, pneumonia, or PCP, cryptococcus. sarcomenogitis, cytomegalovirus or CMV, toxoplasmosis, tuberculosis, and thrush. Thrush is an HIV, a common HIV-related condition. And candidiasis is a overgrowth of candida 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 gonna 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 asymptomatic 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 candidiasis. They had thrush, and thrush is an HIV-related condition. So the patient is HIV positive, but the documentation says they're asymptomatic upon 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 immunodeficiency 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 b20 and notice z21 does not have that note it can't have that note because if a patient has manifestations then it's no longer asymptomatic it is symptomatic all right so our guidance tells us to sequence first b20 followed by the hiv related condition and if we go down to candid diases b37.0 is our code 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 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 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. 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. 098.712Z21B37.0. B. 024.410. 098.712Z21. C. 098. 098.713 B20 and B37.0 D B20 098.713 B37.0. 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 strep 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 nystatin swish and swallow which of the following best describes the encounter all right your time begins now Thank you. 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, 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 plaque. on the patient's tongue which bled diagnosed with rush 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, two, nine. Outstanding. All right. So what about loss of taste? Yeah, it's related to thrush or maybe HIV. I don't know. Painful burning? Hmm. 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 the white tongue plaque and bleeding of the tongue, that's related to thrush too. So 1, 2, 9 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 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 says chapter 15 codes always have sequencing priority. Look at D he 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 098.7 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, gotta 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 098.7 and then use all additional codes to identify the manifestations, right? we're going to eliminate d because d is coding for b20 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 answers here. At 098.7, there's guidance too. It tells you to use additional codes. Additional means sequence after me, sequence after 098.7. And we did, right? We're going to sequence B20 after 098.713, but let's look down 098.713. This is human immunodeficiency 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 candidiasis b37.0 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 already yeah you don't see any ant you don't see any multiple choice yeah we've practiced so much that at least you can kind of figure out you can be in the ballpark all right so code the encounter peggy has been hiv positive for five years she's 20 weeks pregnant. She arrived at the ED with labored breathing. After tests, she is diagnosed with AIDS with pneumocystitis carini, pneumonia, ECP. All right, coders, I'm going to give you, I think this is two minutes. Your time begins now. Yes, this one is a little more, 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, diagnosed with AIDS with pneumocystitis carini pneumonia. All right, coders. Do you all remember me saying that? The common HIV related conditions? Yeah. The pneumocystitis carini. 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 pneumocystitis carini 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. It's telling you to sequence as such, 098.7 and B20, followed by B20, and then the HIV-related condition. This is HIV-related 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 098.71. 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 purpureum. 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, 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. 098.7, human immunodeficiency virus, HIV. This is correct. And then it tells us use additional codes for the HIV. Then we go down further and we're gonna look for our trimester. Our patient is 20 weeks pregnant. So 28 weeks, excuse me, 28 weeks is the third trimester. And I'm going here and I'm gonna locate 098. point seven one three 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 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. I understand. Hang 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 just showing too much. Here we go. Now I'm back. All right, so here we go. Now we know our 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 098.7 followed by the b20 and then we're going to use additional codes to code all manifestations of the HIV infection which is PCP pneumocystitis carini hiv all right b59 and i'm gonna 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 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'ma 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'm going to let that marinate. 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 be specific. I'm going to try and answer you. And while you're doing that, being specific in the chat, Mr. Sandeep, please and thank you. Thanks for tuning in. And until next time, happy coding.

talk about those guidelines and how to apply them. So let's begin with HIV. HIV is the acronym for Human Immunodeficiency 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 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 with 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 symptomatic means without. A means without. Symptomatic means symptom. 098.7. This is HIV disease complicating pregnancy, childbirth, and the purpureum.

And here are some things that you'll need to remember. When you are seeking... sequencing HIV-AIDS, if the reason for the encounter or the RFE is an HIV-AIDS-related condition, then 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, followed by the reason for 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'm 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 laboratory test. The results are inconclusive.

Which code do you assign? Look at that. I'm going to 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. Yeah, 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 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 the 20.6. So anytime they've been in contact with and suspected to exposure to HIV, there you go. All right, next one, encounter for screening for HIV.

Encounter for screening. 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, boom, Z21. Outstanding. Z21 category. Now, all right, so we got you going a little bit. And no, you don't have to memorize these.

The only one I think you should memorize, B20 and Z21. 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. Don't... Don't highlight your procedures.

Don't do that. Because we're only talking about diagnoses. 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 diagnoses, signs, and symptoms. Number two, you identify that first listed code.

And three, apply all guidelines. this is 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 ranges 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.

look up every code because if this is a multiple choice 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 RFE chart. No, we're not going to do all of these columns, but I want you to pay attention to the signs and symptoms. Remember, they can be coded and they can be first listed with no diagnosis as 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 I've told you to make sure you pay attention to these categories on site and also pay attention to that first listed code chart when it comes to signs and symptoms.

And the reason is because we tell you to read 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 ICD-10-CM codes best describes this scenario? A, Z21.

You should know what Z21 is. 098.712. B, 024.414. 098.711. Z21.

Z3A.16. C, 024.414. 098.712, Z21, Z3A.16, and D024.41.

0, 0, excuse me, B20, 098.712, and Z3A.16. 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 ICD-10-CM codes best describes this scenario? All right, coders, you have two minutes to solve, and your time begins now. 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 keywords. All right. We have a pregnant female patient.

16 week. 16 week follow up visit. This patient has gestational diabetes.

And This diabetes is controlled with diet. She is HIV positive, but her lab results have been within normal limits. And she has remained asymptomatic throughout her pregnancy.

All right. So hopefully these are your keywords. And I want an inventory because this inventory thing is really, 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. Somebody said we're eliminating A because it has two codes.

Hmm. 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 C1A2G. And what I'm going to focus on is this third column. It says chapter 15. 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, outstanding, you're spot on. All right, also above this green box, it tells you how it should be sequenced. It's saying first, 098.7. 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'm going to let that marinate. 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 to 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 immunodeficiency virus disease complicating pregnancy, 098.7. 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 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 024.414 and c is coding for 024.410 so i'm going to look it up an 024.4 subcategory is for gestational diabetes mellitus so they're both correct they're both in the correct subcategory But if we go down to 024.410 code and 024.414 code, O0 is coding for gestational diabetes, malady, and pregnancy diet controlled.

14 is coding for insulin controlled. And if you remember our documentation, it says it's controlled with diet. So... 024.410 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. 098.7, this is HIV disease, complicating pregnancy, childbirth, and a purpureum. 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 098.7, 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 098.7 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, Z3A.16, and she's 16 weeks. And if you need to know, the trimesters is in your 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 ICD-10-CM codes should be reported?

A, B20, F1.9, F4.1.9, I10. B, F4.1.9, Z21. C, F4.1.9, D, B20, R06.02, F53.83, I10.

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 Xanax for anxiety, low flow oxygen, and an 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 keywords. 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 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, you know, main terms versus diagnoses, 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 called me a dudette.

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 temporarily or episodic, a 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 gonna be coding for. But I'm still gonna go and check out my guideline. There's a guideline for HIV infection illness, guideline C1A1.

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 i10 this is the code for essential hypertension this includes high blood pressure not elevated elevated blood pressure is not the same okay i just want to 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 r06.9 is dipsnia 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 that was a good one That's what I love to hear. Let me know. Talk to me.

All right. What are the appropriate ICD-10-CM codes for this encounter? A.

B20, J30.2. B. J30.2, Z21. C. J30.2, B20.

And D B20, R09.81, R05.9. Jane is a... 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. I think my clock just stopped. So I am going to continue, if you don't mind.

All right, so here are my key terms. AIDS patients, 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 diagnoses?

There you go. People are 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 non-related 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 antihistamine. nothing was done for her HIV AIDS, her AIDS, nothing. So I'm gonna say seasonal allergies is the chief RFE.

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 giving 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 rfe first and the rfe 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, 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 RFE. So we've gotten rid of A and D because of the human um deficient 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 d so you got to go to so just so you know the asymptotic asymptomatic hiv is not correct because this patient does have AIDS, got to go.

And let's look at C, J30, vasomotor, and allergic rhinitis. And if you look below, J30.2, other seasonal, allergic rhinitis 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, unseat that.

Sorry about that. I should switch these up, but I don't want to do that. It'd take too long. I apologize for that. Let me check and make sure that doesn't happen again.

All right, so this is going to be a good, this is going to be a teachable moment. All right, of the following, which ICD-10-CM codes best describes this encounter? A, B20, B37.9, B, B37.9, B20, C, B37.9, Z21, and D Z21B37.9.

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 candidiasis. Following a positive culture, the patient was diagnosed with thrush.

the physician prescribed nystatin swish and swallow to treat the candidiasis of the following which ICD-10-CM 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 studied 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 keywords hiv positive and asymptomatic oral pain extreme discomfort, patches, white patches in mouth, soreness, signs of candidiasis, thrush, candidiasis. In my inventory is such HIV positive, asymptomatic, oral pain, extreme discomfort, white mouth patches, soreness. signs of candidiasis and thrush and finally candidiasis. 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 hmm could be all right somebody said one and nine somebody said one two nine okay well what about oral pain we know oral pain is related to both thrush and candidiasis right so you gotta go Extreme discomfort can be related to being HIV positive, but maybe not asymptomatic, right? White mouth patches, yeah, thrush, candidiasis. Soreness, thrush, candidiasis. Signs of candidiasis is related, is a clinical indicator of candidiasis, right? And thrush.

is related to candidiasis. I think overgrowth of thrush can cause candidiasis. All right. So this patient is HIV positive and asymptomatic.

Doesn't seem like 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 an 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 says common HIV-related conditions here. You have Kaposi's sarcoma, lipoma, pneumocystitis, cystitis, carini, pneumonia, or PCP, cryptococcus. sarcomenogitis, cytomegalovirus or CMV, toxoplasmosis, tuberculosis, and thrush.

Thrush is an HIV, a common HIV-related condition. And candidiasis is a overgrowth of candida 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 gonna 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 asymptomatic 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 candidiasis. They had thrush, and thrush is an HIV-related condition. So the patient is HIV positive, but the documentation says they're asymptomatic upon 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 immunodeficiency 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 b20 and notice z21 does not have that note it can't have that note because if a patient has manifestations then it's no longer asymptomatic it is symptomatic all right so our guidance tells us to sequence first b20 followed by the hiv related condition and if we go down to candid diases b37.0 is our code 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 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 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. 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. 098.712Z21B37.0. B. 024.410. 098.712Z21.

C. 098. 098.713 B20 and B37.0 D B20 098.713 B37.0. 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 strep 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 nystatin swish and swallow which of the following best describes the encounter all right your time begins now Thank you.

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, 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 plaque. on the patient's tongue which bled diagnosed with rush 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, two, nine. Outstanding. All right. So what about loss of taste? Yeah, it's related to thrush or maybe HIV.

I don't know. Painful burning? Hmm.

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 the white tongue plaque and bleeding of the tongue, that's related to thrush too. So 1, 2, 9 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 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 says chapter 15 codes always have sequencing priority. Look at D he 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 098.7 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, gotta 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 098.7 and then use all additional codes to identify the manifestations, right?

we're going to eliminate d because d is coding for b20 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 answers here. At 098.7, there's guidance too. It tells you to use additional codes.

Additional means sequence after me, sequence after 098.7. And we did, right? We're going to sequence B20 after 098.713, but let's look down 098.713.

This is human immunodeficiency 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 candidiasis b37.0 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 already yeah you don't see any ant you don't see any multiple choice yeah we've practiced so much that at least you can kind of figure out you can be in the ballpark all right so code the encounter peggy has been hiv positive for five years she's 20 weeks pregnant. She arrived at the ED with labored breathing.

After tests, she is diagnosed with AIDS with pneumocystitis carini, pneumonia, ECP. All right, coders, I'm going to give you, I think this is two minutes. Your time begins now.

Yes, this one is a little more, 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, diagnosed with AIDS with pneumocystitis carini pneumonia.

All right, coders. Do you all remember me saying that? The common HIV related conditions?

Yeah. The pneumocystitis carini. 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 pneumocystitis carini 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.

It's telling you to sequence as such, 098.7 and B20, followed by B20, and then the HIV-related condition. This is HIV-related 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 098.71. 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 purpureum. 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, 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. 098.7, human immunodeficiency virus, HIV. This is correct. And then it tells us use additional codes for the HIV.

Then we go down further and we're gonna look for our trimester. Our patient is 20 weeks pregnant. So 28 weeks, excuse me, 28 weeks is the third trimester. And I'm going here and I'm gonna locate 098. point seven one three 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 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. I understand. Hang 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 just showing too much. Here we go. Now I'm back.

All right, so here we go. Now we know our 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 098.7 followed by the b20 and then we're going to use additional codes to code all manifestations of the HIV infection which is PCP pneumocystitis carini hiv all right b59 and i'm gonna 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 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'ma 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'm going to let that marinate. 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 be specific.

I'm going to try and answer you. And while you're doing that, being specific in the chat, Mr. Sandeep, please and thank you. Thanks for tuning in.

And until next time, happy coding.

Transcript for:HIV Coding Guidelines

Transcript for:
HIV Coding Guidelines