Question

There are exceptions to the coding guidelines as they apply to possible and probable conditions. However, there is an exception with HIV disease. HIV must be confirmed by the physician’s diagnostic statement in order to code. Why is this an exception to the guidelines? What issues can patients with AIDS or HIV face?

Answer 1

HIV mus be confirmed by the physician's diagnostic statement in order to code. This is an exception to guideline 1.8 which states" If the diagnosis is documented at the time of discharge is qualified as probable, suspected, likely, questionable, possible or still to be ruled out, code the condition if it existed or was established".  

HIV diseases confirmation doses not require documentation of positive serology or positive culture for HIV , the physician's diagnostic statement that patient is having HIV diseases or HIV related infection is sufficient to assign coding. However, if physician is doubtful and documents at discharge that the condition is probable case of HIV or the patient probably has AIDS, the condition cannot be coded as existed or established. This is because  HIV cases are never reported unless a patient has confirmed diagnosis. They need a confirmed diagnosis in order to report a condition. Regardless of setting, coders can only code HIV once it is confirmed.

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