1. Infectious Diseases Part 1

2.  Infectious and Parasitic Diseases ◦ Divided based on etiology (cause of disease) ◦ Many combination codes ◦ Example: 112.0 candidiasis infection of mouth, which reports both organism and condition with one code

3.  Sequencing must be considered ◦ UTI due to Escherichia coli  599.0 (UTI) etiology  041.4 (E. coli) organism ◦ 041 category is a secondary-code only

4.  Code HIV or HIV-related illness ONLY if stated as confirmed in diagnostic statement  042 HIV or HIV-related illness  V08 Asymptomatic HIV status  795.71 Nonspecific HIV serology  Once an HIV diagnosis cannot code V08

5.  Code prior diagnosis HIV-related disease 042 (HIV)  NEVER assign these patients to: ◦ V08 (asymptomatic) or ◦ 795.71 (Nonspecific serologic evidence of HIV)

6.  If admitted for HIV-related illness (e.g., pneumonia) ◦ Code 042 (HIV) ◦ Followed by current illness (Pneumocystis carinii, 136.3)  If admitted for other than HIV-related illness ◦ Code first-listed diagnosis ◦ Then 042 (HIV) (Cont’d…)

7. (…Cont’d)  Sequence  Reason most responsible for encounter, if HIV (042) ◦ Any additional diagnosis that impacts treatment

8.  Exception to HIV sequencing  During pregnancy, childbirth, or puerperium, code: ◦ 647.6X (Other specified infections and parasitic diseases) ◦ Followed by 042 (HIV) (stated diagnosis) ◦ Then any HIV-related illness (Cont’d…)

9. (…Cont’d)  Asymptomatic HIV during pregnancy, childbirth, or puerperium ◦ 647.6X (Other specified infections and parasitic diseases) and ◦ V08 (Asymptomatic HIV infection status)

10.  795.71 (Inconclusive serologic test for HIV)

11.  Code V73.89 (Screening for other specified viral disease) ◦ Patient in high-risk group for HIV ◦ V69.5 (Other problems related to lifestyle)  Patients returning for HIV screening results = V65.44 (HIV counseling)

12.  Incorrectly applying these HIV coding rules can cause patient hardship ◦ Insurance claims for patients with HIV usually need patient’s written agreement to disclose

13.  Fever  Change in heart rate  Increased white blood cell count

14.  Septicemia: systemic disease of microorganisms or their toxins in the blood (blood poisoning)  Septic shock: overwhelming infection due to severe sepsis  SIRS: Systemic Inflammatory Response Syndrome is a systemic response to infection/trauma  Sepsis refers to SIRS due to infection  Severe sepsis is sepsis with acute organ dysfunction

15. (…Cont’d)  Code septicemia (038.XX)  Code SIRS with two codes: ◦ First underlying systemic infection ◦ Second (995.9X) Code Severe sepsis with three codes : First underlying systemic infection condition Second 995.92 Third, use additional code to identify organ failure

16.  If documented, septic shock (785.52) should be reported  Septic Shock ( code four codes)  First code systemic infection  Second, 995.92 (or 995.94 if injury)  Third, code to identify organ failure  Fourth, 785.52  Sepsis and septic shock associated with OB codes, also use code 630-633, Ectopic and Molar Pregnancy  Septic shock is never primary or first-listed diagnosis

17.  Infection resulting from Trauma, Other Serious Injury, Pancreatitis ◦ Code Trauma/Injury ◦ SIRS second (995.9X) ◦ Any acute organ dysfunctions

18. Conclusion - Infectious Diseases