ICD-10 Coding for HIV Screening(Z11.4, Z20.6, B20)
Complete ICD-10-CM coding and documentation guide for HIV Screening. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to HIV Screening
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Z11.4 | Encounter for screening for human immunodeficiency virus [HIV] | Use for routine HIV screening encounters without symptoms or known exposure. |
|
| Z20.6 | Contact with and (suspected) exposure to human immunodeficiency virus [HIV] | Use when there is documented exposure or high-risk behavior. |
|
| B20 | Human immunodeficiency virus [HIV] disease | Use for confirmed HIV diagnoses with symptoms or history of AIDS. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for HIV screening
Essential facts and insights about HIV Screening
Primary ICD-10-CM Codes for human immunodeficiency virus screening
Decision Criteria
clinical Criteria
- Patient presents for routine screening without symptoms.
Clinical Validation Requirements
- Documentation of routine screening intent
- Negative or pending test results
Code-Specific Risks
- Incorrectly using for diagnostic testing in symptomatic patients
Coding Notes
- Ensure documentation specifies the screening nature of the visit.
Z20.6 - Contact with and (suspected) exposure to human immunodeficiency virus [HIV]
Use when there is documented exposure or high-risk behavior.
Applicable To
- Suspected exposure to HIV
Excludes
- Routine HIV screening (Z11.4)
Clinical Validation Requirements
- Documented exposure risk or high-risk behavior
Coding Notes
Ensure exposure risk is clearly documented.
B20 - Human immunodeficiency virus [HIV] disease
Use for confirmed HIV diagnoses with symptoms or history of AIDS.
Applicable To
- AIDS
- HIV infection, symptomatic
Excludes
- Asymptomatic HIV infection status (Z21)
Clinical Validation Requirements
- Confirmed HIV diagnosis with symptoms or history of AIDS-defining illness
Coding Notes
Ensure symptoms or history of AIDS are documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
HIV counseling
Z71.7Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting HIV Screening to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z11.4.
Impact
Clinical: Misrepresents the purpose of the visit., Regulatory: Non-compliance with coding guidelines., Financial: Potential claim denials.
Mitigation Strategy
Verify the purpose of the test before coding.
Impact
Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate patient records and data reporting.
Mitigation Strategy
Use B20 if the patient is on antiretroviral therapy.
Impact
Using Z21 for symptomatic patients or those on antiretrovirals.
Mitigation Strategy
Regular training on ICD-10 coding updates.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for HIV Screening, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for HIV Screening
Use these documentation templates to ensure complete and accurate documentation for HIV Screening. These templates include all required elements for proper coding and billing.
Routine HIV Screening
Specialty: Primary CareRequired Elements
- Screening indication
- Consent
- Test method
- Results
- Counseling provided
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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