Q&A: Reporting COVID-19 with HIV ICD-10-CM

Q: We have a patient that was admitted with sepsis due to novel coronavirus (COVID-19) who also has human immunodeficiency virus (HIV). How should we report this in ICD-10-CM, and which MS-DRG would this be assigned to?

A: Patients with HIV are more susceptible to being infected by COVD-19 due to being immune compromised, HIV does not cause COVID-19. The sequencing would be based on the circumstances of the admission.

The specific MS-DRG assignment would be determined by whether or not the provider documents the sepsis as an HIV-related illness. Sepsis is identified as an HIV-related illness; however, coders cannot assume a linkage between the two conditions. Per Coding Clinic, First Quarter 2019, provider documentation must specifically indicate that the patient has an HIV-related illness prior to the assignment of ICD-10-CM code B20 (human immunodeficiency virus [HIV] disease).

Coding Clinic went on to say that it would not be appropriate to automatically link a diagnosis as an HIV-related condition based solely on the Centers for Disease Control and Prevention’s AIDS-Defining Illnesses list and/or conditions included in major diagnostic category 25 (HIV Infections). If the documentation is unclear or ambiguous regarding the patient’s HIV status, the provider should be queried.

Diagnosis codes B20, A41.89 (other specified sepsis), and U07.1 (COVID-19) would be assigned if the documentation specifies a linkage of the two conditions. ICD-10-CM codes A41.89, U07.1, Z21 (asymptomatic human immunodeficiency virus [HIV] infection status), could also be assigned in the absence of linking documentation by the provider.

Lastly, if sepsis developed solely after inpatient admission, U07.1 could also meet the criteria for principal diagnosis if that was the reason for admission. Additional codes would be assigned for sepsis and the HIV status.

Please also note prior guidance about sequencing sepsis and COVID-19 must also be considered for ultimate MS-DRG assignment. If code B20 is assigned, the MS-DRG assigned would be classified to MS-DRGs 969-970 (Surgical DRGs) or 974-977 (Medical DRGs) depending on whether an extensive OR procedure was performed.

Editor’s note: Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O, director of HIM/Coding at HCPro in Middleton, Massachusetts, answered this question. Contact her at smccall@hcpro.com.

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.