WHAT IS WORLD AIDS DAY?
World AIDS Day is held on the 1st December each year and is an opportunity for people worldwide to unite in the fight against HIV, show their support for people living with HIV and to commemorate people who have died. World AIDS Day was the first ever global health day, held for the first time in 1988.
WHY IS WORLD AIDS DAY IMPORTANT?
More than 1.2 million people in the United States are living with HIV infection, and almost 1 in 8 (12.8%) are unaware of their infection. Globally there are an estimated 34 million people who have the virus. Despite the virus only being identified in 1984, more than 35 million people have died of HIV or AIDS, making it one of the most destructive pandemics in history.
Today, scientific advances have been made in HIV treatment, there are laws to protect people living with HIV and we understand so much more about the condition. In 2013, an estimated 47,352 people were diagnosed with HIV infection in the United States. In that same year, an estimated 26,688 people were diagnosed with AIDS. Many people do not know the facts about how to protect themselves and others, and stigma and discrimination remain a reality for many people living with the condition.
World AIDS Day is important because it reminds the public and Government that HIV has not gone away – there is still a vital need to raise money, increase awareness, fight prejudice and improve education.
(Excerpts from CDC Below)
HIV is a virus spread through certain body fluids that attacks the body’s immune system, specifically the CD4 cells, often called T cells. Over time, HIV can destroy so many of these cells that the body can’t fight off infections and disease. These special cells help the immune system fight off infections. Untreated, HIV reduces the number of CD4 cells (T cells) in the body. This damage to the immune system makes it harder and harder for the body to fight off infections and some other diseases. Opportunistic infections or cancers take advantage of a very weak immune system and signal that the person has AIDS. Learn more about the stages of HIV and how to know whether you’re infected.
Stages of HIV
When people get HIV and don’t receive treatment, they will typically progress through three stages of disease. Medicine to treat HIV, known as antiretroviral therapy (ART), helps people at all stages of the disease if taken the right way, every day. Treatment can slow or prevent progression from one stage to the next. It can also dramatically reduce the chance of transmitting HIV to someone else.
Stage 1: Acute HIV infection
Within 2 to 4 weeks after infection with HIV, people may experience a flu-like illness, which may last for a few weeks. This is the body’s natural response to infection. When people have acute HIV infection, they have a large amount of virus in their blood and are very contagious. But people with acute infection are often unaware that they’re infected because they may not feel sick right away or at all. To know whether someone has acute infection, either a fourth-generation antibody/antigen test or a nucleic acid (NAT) test is necessary. If you think you have been exposed to HIV through sex or drug use and you have flu-like symptoms, seek medical care and ask for a test to diagnose acute infection.
Stage 2: Clinical latency (HIV inactivity or dormancy)
This period is sometimes called asymptomatic HIV infection or chronic HIV infection. During this phase, HIV is still active but reproduces at very low levels. People may not have any symptoms or get sick during this time. For people who aren’t taking medicine to treat HIV, this period can last a decade or longer, but some may progress through this phase faster. People who are taking medicine to treat HIV (ART) the right way, every day may be in this stage for several decades. It’s important to remember that people can still transmit HIV to others during this phase, although people who are on ART and stay virally suppressed (having a very low level of virus in their blood) are much less likely to transmit HIV than those who are not virally suppressed. At the end of this phase, a person’s viral load starts to go up and the CD4 cell count begins to go down. As this happens, the person may begin to have symptoms as the virus levels increase in the body, and the person moves into Stage 3.
Stage 3: Acquired immunodeficiency syndrome (AIDS)
AIDS is the most severe phase of HIV infection. People with AIDS have such badly damaged immune systems that they get an increasing number of severe illnesses, called opportunistic illnesses.
Without treatment, people with AIDS typically survive about 3 years. Common symptoms of AIDS include chills, fever, sweats, swollen lymph glands, weakness, and weight loss. People are diagnosed with AIDS when their CD4 cell count drops below 200 cells/mm or if they develop certain opportunistic illnesses. People with AIDS can have a high viral load and be very infectious.
Getting Tested: Knowing Your Status
The only way to know for sure whether you have HIV is to get tested. Knowing your status is important because it helps you make healthy decisions to prevent getting or transmitting HIV.
Some people may experience a flu-like illness within 2 to 4 weeks after infection (Stage 1 HIV infection). But some people may not feel sick during this stage. Flu-like symptoms include fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes, or mouth ulcers. These symptoms can last anywhere from a few days to several weeks. During this time, HIV infection may not show up on an HIV test, but people who have it are highly infectious and can spread the infection to others.
If you have these symptoms, that doesn’t mean you have HIV. Each of these symptoms can be caused by other illnesses. But if you have these symptoms after a potential exposure to HIV, see a health care provider and tell them about your risk. The only way to determine whether you are infected is to be tested for HIV infection.
To find places near you that offer confidential HIV testing,
You can also use a home testing kit, available for purchase in most pharmacies and online.
After you get tested, it’s important to find out the result of your test so you can talk to your health care provider about treatment options if you’re HIV-positive or learn ways to prevent getting HIV if you’re HIV-negative.
No effective cure currently exists for HIV. But with proper medical care, HIV can be controlled. Treatment for HIV is called antiretroviral therapy or ART. If taken the right way, every day, ART can dramatically prolong the lives of many people infected with HIV, keep them healthy, and greatly lower their chance of infecting others. Before the introduction of ART in the mid-1990s, people with HIV could progress to AIDS (the last stage of HIV infection) in a few years. Today, someone diagnosed with HIV and treated before the disease is far advanced can live nearly as long as someone who does not have HIV.
Coding HIV and AIDS
There are several rules to keep in mind when coding HIV. Most importantly one should only code confirmed cases. There are guidelines for coding HIV in ICD-10-CM that are the same in ICD-9-CM; only the codes have changed, along with additional codes for testing and counseling.
A patient who is HIV-positive, with no HIV-related illnesses has an “HIV-positive status,” code Z21, as opposed to the patient who has ever had any HIV-related illness, which is then coded as B20. (*Note that in California, legislation was passed to make it illegal to report an HIV-positive status without the patient’s consent. In these cases, an unspecified viral diagnosis code is used.) Note that the provider’s documentation of “HIV-positive” or “AIDS” is sufficient for coding purposes, and corresponding lab results are not necessary.
Examples of HIV codes:
Z20.6 Contact with and exposure to human immunodeficiency virus (HIV)
Z11.4 Encounter for screening for human immunodeficiency virus (HIV)
Z71.7 Human immunodeficiency virus (HIV) counseling
(Used for HIV related counseling at the time of testing as well as return for test results. If testing is positive, then follow other code assignments based on presentation of illnesses.)
Z21 Asymptomatic human immunodeficiency virus (HIV) infection status
(Only used if/when patient is HIV-positive, with no HIV-related illnesses since their positive status)
B20 Human immunodeficiency virus (HIV) disease
(Only used if/when patient has an HIV-related illness, and all times subsequently. The patient who had previous illnesses, and is “undetectable” today, will always carry a B20 code, and never go back to a Z21 code.)
R75 Inconclusive laboratory evidence of human immunodeficiency virus (HIV)
(Only used when status is unconfirmed or inconclusive; this is often used for infants born of HIV positive mothers as they may often seroconvert to HIV-negative status.)
HIV Sequencing Rules
- Patient admitted for HIV-related condition: The principle diagnosis should be B20, HIV disease, followed by additional diagnosis codes for all reported HIV-related conditions. (ICD-10-CM)
- Patient with HIV admitted for unrelated condition: The code for the unrelated condition should be listed as the principle diagnosis. Other diagnoses would include B20, followed by additional diagnoses for HIV-reported conditions. (ICD-10-CM)
- HIV infection in pregnancy, childbirth, and the puerperium: During pregnancy, a patient admitted (or presenting for an encounter) because of an HIV-related illness, should receive a principal diagnosis code of 7-, Human immunodeficiency disease complicating pregnancy, childbirth, and the puerperium, followed by B20 and the code(s) for the HIV-related illness(es). Note that codes from Chapter 15 (O codes) always take sequencing priority. (ICD-10-CM)
Brian Boyce, BSHS, CPC, CPC-I, CRC, CTPRP is an AAPC-approved PMCC medical coding instructor, and ICD-10-CM trainer and the author of the AAPC CRC® curriculum. He has specialized in risk adjustment from the very beginnings of these models being utilized and has assisted large and small clients nationally. He has special interest in ethics, patient safety, disease management, and management and leadership of people. Brian is a veteran of Desert Storm, where he served on active duty with the US Air Force with a job specialty of Aeromedical Evacuation. He went into physician practice management and medical coding after an honorable discharge. He is the CEO of ionHealthcare® LLC, a company that specializes in healthcare consulting, risk adjustment coding, management & support services. For additional inquiries contact ionHealthcare® at info@ionHealthcare.com.