Icd 10 Code For Uncontrolled Diabetes

Icd 10 Code For Uncontrolled Diabetes. Diabetes is a very significant illness and destructive sickness. This post will provide you with several diabetes mellitus comprehend and handle their condition.

q: “on the hiv codes, when do you use thez code versus the b code? would you code the patient as being active if they have historyof hiv?” a: when we start looking at the aids and hivcodes, we originally received this question that came asking, “when do we use that zcode versus when do we use the 042 in icd-9?” so we went update it for icd-10.

i’m reiterating some of the informationthat tammy and alicia covered when they covered this topic back in august, but i looked atit from a little bit different perspective. you’ll find i’m huge on citing my sources,so i wanted to give you where i found the information that helped me make my decisionin when do i use the z code, the z21 versus

the b20. when we first start looking at hiv, the importantthing to understand here is that a patient at this point in time cannot have a historyof hiv, it’s not possible. we do not yet have a cure for hiv. once the patient hashiv, they have hiv for life. from a coding perspective, it simplybecomes do they havesymptomatic hiv or do they have asymptomatic hiv? we’ll scroll down a little bit farther andwe’re going to talk about how do we figure out what constitutes asymptomatic, which isthe z21, versus what constitutes symptomatic, which is b20.

it was funny because when we were lookingat our answer sheets earlier today, alicia goes, “i love this little timeline thing,how do you get that?” i said, “the cdc website” because that’s actually wherethis came from. what i did is, if you didn’t know this, the federal government, our federalgovernment here in the united states has a website devoted to aids and hiv because foryears it was so rampant and it’s still a very large thing that we have to deal with. they actually estimate that up to 18% of thepopulation that has hiv has no idea that they have hiv because they’re asymptomatic. whatthey explained is that there are really three stages of hiv. there’s the acute infectionpoint where the person first gets infected

and their body, it’s a virus so it’s replicatingconstantly. that’s that acute infection timeframe. usually, they might have some flu-likesymptoms. it’s going to be a bad flu, it’s not going to be, “oh, that was a piece ofcake.” that’s kind of all the more they’re going to get. they’re not going to know.it’s not going to be any abnormal, crazy, “oh, i must have hiv, that’s what thisis.” then, they fall into a period of what we callclinical latency. that means that the virus is just there, doing its thing replicating,not making them sick but continuing to spread throughout their bloodstream. it’s reproducingat a lower level than that initial thing, but it’s still considered active infection.both of these, we’re still talking about

an asymptomatic patient. they have not yethad a symptom related to their hiv. when we talk about symptoms related to theirhiv, cdc actually defines aids, their cd4 cells fall below 200 cells and that’s whenit’s progressed to aids. they actually go up to explain that it’s not just the cd4blood counts, it’s actually about whether or not a patient has had what we call an oior an opportunistic infection. those first two stages, the acute infection,the clinical latency, we don’t have any symptoms associated with those. yeah, theythought they had the flu, but it’s not necessarily asymptomatic, it’s not an opportunisticinfection. when we start looking through here, the guidelines actually say, “ok, if they’venot had a symptom of hiv, they’re asymptomatic.”

usually, the provider is going to call thishiv positive, known hiv, they have a history of an hiv-positive test. the important thing to note here is this isnot where the provider uses the phrase aids, and i did not put this in this note, but thiswas a question that i have had people ask me as i’ve done trainings, this is not ifa provider writes the word arc (aids-related complex). that’s actually a lot of providersin the infectious disease world will call it arc when the patient is first beginningto experience an opportunistic infection, which is an hiv-related illness. notice both of these guidelines for symptomaticand asymptomatic revolve around: has the patient

had, either currently or in the past an hiv-relatedillness? if they’ve had an hiv-related illness, they get coded as symptomatic hiv. the aids.gov website goes on to explain: anhiv-related illness is these opportunistic infections (sometimes referred to as oi).the aids.gov web address actually says there are 20 opportunistic infections that by default,if you have a patient with known hiv, since the time of their diagnosis with hiv has hadone of these conditions, they have full-blown aids. period. once they have aids, they haveaids for the rest of their life. once they go from that z21, that asymptomatic statusto having an opportunistic infection, they move into the b20 world. they stay in thatb20 world for life. even if we treat that

opportunistic infection and it goes away,things like... if you’ll scroll a little farther up, it will give you that full listof b20. when we talk about opportunistic infections,these are things that take advantage of the patient’s weakened immune system. i thinkabout it as, it’s going to take a patient nearly to death’s door, and it could potentiallybe fatal for them. if we start looking at these, think about this. candidiasis of bronchi,trachea, esophagus, lungs, that’s a fungal infection down in there. a patient with aidsor with hiv has a compromised immune system, they’re not going to be able to fight offthese infections as well as a normal healthy patient would.

by definition, if a patient has hiv, and theyhave or since the time of their diagnosis has had one of these 20 conditions, they haveaids, they have full-blown aids. the most common question i get is, “well, the doctordidn’t call it aids.” if the doctor documents known hiv and then the history it says “historyof invasive cervical cancer.” at a bare minimum, you need to be querying the providerand going, “was that before or after their hiv diagnosis? is it related?” because ifit’s related, that patient has aids, they should be reported using b20. that’s one of the things i see most frequently.i see a lot of coders go, “well, the doctor didn’t say that, the doctor just said this...”it comes down to understanding the disease

process and knowing these different piecesto know what to look for in the record. because yeah, the doctor may have said down here hivpositive, but in the history they may have said “hiv positive with a history of histoplasmosis.”well, i got news, histoplasmosis is almost always hiv-related. you need to know when to ask the questionsof your providers and by asking those questions, you’re going to begin to – i know thissounds funny – you’re going to begin to train most providers as to what needs to bethere when they’re diagnosing aids and hiv. another common question i get is, “whatif our doctor doesn’t know that they’ve had one of these opportunistic infectionsand just write ‘hiv positive’ and i coded

it as a z21.” we already have that problemwith the icd-9 codes that we did before we went to icd-10, the same process is likelyto occur. if you’re not familiar with that process, when you report those codes to theinsurance company they’re looking at their files and they’re going, “oh, but we showedthat this patient actually has aids.” more than likely, what happens is you geta letter from the insurance company saying, “according to our records, this is a patientwith full-blown aids. please verify your documentation so that you know, “oh! we need to get clarificationfrom the patient or from the patient’s past medical records, but it looks like we needto adjust our diagnosis because they don’t really just have hiv, they have full-blownaids.” oftentimes, is that the provider

doesn’t know the nuances and the differencesfrom a coding perspective, because remember, coding and clinical don’t always match 100%.we’ve got to come to that common language and explain how it’s different from a codingperspective. for aids and hiv, when we talk about b20 andz21, it’s all about are they symptomatic or asymptomatic, which comes down not to theirblood cell counts but have they had an opportunistic infection or hiv-related illness. laureen: just a few clarifying questions thatcame in. lina is asking if the patient is being treatedfor cancer, we don’t need to report their hiv status?

chandra: i would disagree with that statement.every insurance company and actually the coding rules, the way that they have always beenexplained to me, even if you look in the icd-10 guidelines, hiv is the only condition thatis considered to always be clinically significant. it’s expected to be reported on every encounterfor every provider that sees that patient from the time of diagnosis until the timethey expire because it does factor in to so many things and there’s such a high riskaround transmission, but that is the one disease that they track extremely closely. i wouldencourage you to report it on any hiv patient that you see. laureen: debbie said, “so, hiv is eitherasymptomatic or symptomatic, no personal history

of?” chandra: correct; because we can’t cureit yet. laureen: candy said “i’ve always heardthat if the patient has hiv in their past history, you always have to code for hiv.is that true?” chandra: yes. because again, hiv never goesaway. at this point in time, it can’t be cured. it can be controlled with medicationsespecially if we catch it in the asymptomatic phase, but once they have hiv, like i saidbecause we don’t have a cure yet, they have hiv for life. it’s the one condition that’salways considered clinically significant, so it needs to be reported any time that patientis seen. the order simply changes depending

on why they’re there. if you have a patient coming in and this goesback to the icd-10 guidelines, those chapter 1 guidelines. you have a patient coming infor an hiv-related illness, maybe they’re coming in for histoplasmosis, maybe they’recoming in for a kaposi sarcoma. those are things that are inherently hiv-related. theguidelines tell you, “ok, the hiv has to go first.” if they’re coming in for somethingcompletely unrelated, maybe they sprained their ankle, “oh, i sprained my ankle, ineed you to take a look at my ankle,” but

Icd 10 Code For Uncontrolled Diabetes,they find out during the intake this patientis hiv positive. they don’t have aids, they have hiv or if they did have aids, that stillneeds to be reported but the main reason they

were there was the ankle sprain, the hiv wouldbe kind of an “oh, by the way,” at the end that we get put on there.

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