Facebook tracking pixel
Z11.4
ICD-10-CM
HIV Screening

Find comprehensive information on HIV screening, including clinical documentation, medical coding (ICD-10 Z11.4, SNOMED CT 73898005), healthcare guidelines, and testing procedures. Learn about HIV diagnosis, prevention, risk factors, and available resources for patients and healthcare professionals. Explore accurate and up-to-date information on HIV antibody testing, viral load testing, and early detection strategies. This resource supports proper healthcare documentation and facilitates informed decision-making regarding HIV testing and patient care.

Also known as

Human Immunodeficiency Virus Screening
HIV Test

Diagnosis Snapshot

Key Facts
  • Definition : Detecting antibodies to HIV, the virus causing AIDS.
  • Clinical Signs : Often asymptomatic initially, later flu-like symptoms, swollen lymph nodes, fatigue.
  • Common Settings : Primary care clinics, sexual health clinics, testing centers, hospitals.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC Z11.4 Coding
Z11.4

Encounter for HIV screening

Routine HIV screening or testing.

Z71.7

Human immunodeficiency virus [HIV] status

Follow-up care related to confirmed HIV status.

R75

Abnormal immunological findings

May be used if screening reveals immunological abnormalities.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the encounter for HIV screening?

  • Yes

    Is the patient at high risk for HIV?

  • No

    Do not code HIV screening. Code for the reason of encounter.

Code Comparison

Related Codes Comparison

When to use each related code

Description
HIV Screening
Acute HIV Infection
HIV-1 Infection

Documentation Best Practices

Documentation Checklist
  • HIV screening test type (e.g., ELISA, rapid test)
  • Date and time of HIV test
  • HIV test result (positive, negative, indeterminate)
  • Patient consent for HIV testing documented
  • Counseling provided pre and post HIV test

Mitigation Tips

Best Practices
  • Document HIV screening consent per ICD-10 Z11.4 coding guidelines.
  • Ensure accurate SNOMED CT coding for HIV tests (e.g., 1353810000000105).
  • For positive results, specify stage per CDC guidelines for compliant CDI.
  • Review and update HIV screening protocols annually for healthcare compliance.
  • Use compliant EHR templates for accurate, complete HIV screening documentation.

Clinical Decision Support

Checklist
  • Verify patient age eligibility for HIV screening.
  • Confirm absence of previous positive HIV test.
  • Document patient consent or declination for HIV test.
  • Order appropriate HIV antibody/antigen test.
  • Document test type and results in patient record.

Reimbursement and Quality Metrics

Impact Summary
  • HIV Screening Reimbursement: CPT codes 86701, 86702, 86703 impact payment. Accurate ICD-10-CM coding (Z11.4) crucial for maximum reimbursement.
  • Quality Metrics Impact: HEDIS measures assess HIV screening rates. Accurate coding and reporting improves performance scores and value-based payments.
  • Coding Accuracy Impact: Incorrect coding leads to claim denials, reduced revenue. Proper documentation supports accurate HIV screening code assignment.
  • Hospital Reporting Impact: Precise HIV screening data crucial for public health reporting, resource allocation, and program evaluation.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes. Our AI-powered assistant ensures compliance and reduces coding errors.

Frequently Asked Questions

Common Questions and Answers

Q: What are the most recent CDC recommendations for HIV screening in primary care settings, including frequency and patient populations?

A: The CDC recommends routine HIV screening for all individuals aged 13-64 in all healthcare settings, including primary care. For patients at increased risk of HIV (e.g., men who have sex with men, people who inject drugs, transgender women), more frequent screening, at least annually, is recommended. Pregnant women should be screened at their first prenatal visit and again in the third trimester if at continued risk. Opt-out screening, where patients are notified they will be screened unless they decline, is the preferred approach. Explore how these guidelines can be implemented within your specific practice to ensure comprehensive patient care. Consider implementing a standardized HIV screening protocol to streamline the process.

Q: How can I differentiate between false positive HIV antibody tests and actual HIV infection in my clinical practice, and what are the confirmatory testing algorithms to use?

A: False positive HIV antibody tests can occur due to a variety of factors, including certain autoimmune conditions, pregnancy, or recent vaccinations. Differentiating a false positive from a true positive requires confirmatory testing. If an initial antibody test is reactive, the next step is typically a HIV-1/HIV-2 antibody differentiation immunoassay. If this test is positive for HIV-1 antibodies, it is considered a confirmed positive. If the differentiation assay is indeterminate or negative, a nucleic acid test (NAT) is recommended to definitively determine HIV status. Learn more about the latest algorithms and best practices for confirming HIV diagnosis to ensure accurate patient management.

Quick Tips

Practical Coding Tips
  • Code Z11.4 for routine HIV screening
  • R75 for inconclusive HIV test
  • Confirm HIV diagnosis with ICD-10 B20
  • Use Z21 if patient is HIV positive
  • Document screening reason, test type, result

Documentation Templates

Patient presents for HIV screening.  Risk factors assessed include sexual history, intravenous drug use, and previous blood transfusions. Patient reports (insert patient-reported risk factors or denial of risk factors). Physical examination unremarkable.  HIV screening test ordered: (specify test type e.g., fourth-generation HIV-1/2 antigenantibody immunoassay, rapid antibody test).  Pre-test counseling provided, including discussion of HIV transmission, testing methodology, and potential outcomes. Patient demonstrated understanding of the testing process and provided informed consent.  Results pending.  Plan to contact patient with results and provide post-test counseling as appropriate.  If positive, further testing, including HIV RNA viral load and CD4 count, will be ordered.  Referral to infectious disease specialist and initiation of antiretroviral therapy will be considered based on test results.  ICD-10 code Z11.4 assigned for encounter for screening for human immunodeficiency virus.  CPT codes (insert appropriate CPT codes for testing and counseling) billed.

Patient returns for HIV screening results.  The (specify test type e.g., fourth-generation HIV-1/2 antigenantibody immunoassay) returned (positive or negative).  Post-test counseling provided, including interpretation of results and discussion of next steps. For a positive result,  patient was informed about the significance of the positive screening test and the need for confirmatory testing.  HIV RNA viral load and CD4 count ordered. Referral to infectious disease specialist made.  Discussion regarding antiretroviral therapy initiated.  Importance of adherence and follow-up emphasized. For a negative result, patient counseled on risk reduction strategies and the importance of repeat testing based on individual risk assessment.  Information regarding HIV prevention methods, including pre-exposure prophylaxis (PrEP), provided.  Patient education materials distributed.  ICD-10 code (Z11.4 for negative screen, B20 for confirmed HIV) assigned.  CPT codes (insert appropriate CPT codes for testing and counseling) billed.


HIV Screening - AI-Powered ICD-10 Documentation