Q&A: Coding sepsis, COVID-19, and AIDS

Q: How should we code a patient admitted with sepsis due to COVID-19 who also has acquired immunodeficiency syndrome (AIDS)?

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

The specific 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 for ICD-10-CM/PCS, first quarter, 2019, states:

Provider documentation must specifically indicate AIDS or that the patient has an HIV-related illness prior to assigning code B20, Human immunodeficiency virus [HIV] disease. It would not be appropriate to automatically link a diagnosis as an HIV-related condition based solely on the CDC’s AIDS-Defining Illnesses list and/or conditions included in MDC 25. If the documentation is unclear or ambiguous regarding the patient’s HIV status, the provider should be queried for clarification.

Diagnosis codes B20, A41.89 (MCC), and U07.1 (COVID-19) would be assigned if the documentation specifies a linkage of the two conditions OR could be assigned as A41.89, U07.1, Z21, in the absence of linking documentation by the provider and no documentation to support prior HIV-related conditions to allow the reporting of B20. 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 DRG assignment. If code B20 is assigned, the MS-DRG assigned would be classified to MDC 25 MS-DRGs 969-970 or 974-977 depending on whether an extensive O.R. 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.