Human immunodeficiency virus [HIV] disease
chapter 1: Certain Infectious and Parasitic Diseases
- B20 is billable and valid on claims for FY 2027.
- As a secondary diagnosis it is a CC (complication or comorbidity), which can raise the MS-DRG payment. It doesn't count when the principal diagnosis is one of 5 closely related codes.
- Counts toward HCC 1 (HIV/AIDS) in the Medicare Advantage risk model (CMS-HCC V28).
- AHRQ's Chronic Condition Indicator classes it as chronic: expected to last 12 months or longer and to limit daily life or need ongoing care.
- More than 1,528 US deaths in 2024 had an underlying cause in category B20, per the National Vital Statistics System on CDC WONDER. Death records use WHO ICD-10, so the count is for the whole category.
Also indexed as: Acquired, immunodeficiency syndrome; AIDS; ARC; Dementia), in, human immunodeficiency virus disease; Dementia), in, human immunodeficiency virus disease, with behavioral disturbance; Disease, human immunodeficiency virus; Disease, slim; Disease, viral, virus, human immunodeficiency; Encephalitis, due to, human immunodeficiency virus disease; HIV; Human, immunodeficiency virus disease; Human, immunodeficiency virus disease, dementia; Human, immunodeficiency virus disease, dementia, with behavioral disturbance; Slim disease; Syndrome, HIV infection, acute
Advertisements
Instructional notes
Includes: conditions that are coded here
- acquired immune deficiency syndrome [AIDS]
- AIDS-related complex [ARC]
- HIV infection, symptomatic
Excludes1: not coded here, use a different code
Code first: code the underlying condition first, then this code
- Human immunodeficiency virus [HIV] disease complicating pregnancy, childbirth and the puerperium, if applicable (O98.7-)
Use additional code: add a second code for this, listed after this one
- code(s) to identify all manifestations of HIV infection
Official coding guidelines
From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.
- Section I.C.1.a Human Immunodeficiency Virus (HIV) Infections (page 19), covers B20
Code only confirmed HIV, where the provider's statement is enough. Assign B20 for AIDS or any HIV-related illness, Z21 for asymptomatic HIV positive status, and R75 for inconclusive serology. Once B20 applies, use it on every later encounter.
Other Chapter 1 topics:
- Infectious agents as the cause of diseases classified to other chapters (page 22)
- Infections resistant to antibiotics (page 22)
- Sepsis, Severe Sepsis, and Septic Shock (page 23)
- Methicillin Resistant Staphylococcus aureus (MRSA) Conditions (page 27)
- Zika virus infections (page 28)
- Coronavirus infections (page 28)
B20 MS-DRGs
As the principal diagnosis, B20 groups to MS-DRG 969, 970, 974, 975, 976, or 977 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.
- DRG 969 HIV with Extensive O.R. Procedures with MCC
- DRG 970 HIV with Extensive O.R. Procedures without MCC
- DRG 974 HIV with Major Related Condition with MCC
- DRG 975 HIV with Major Related Condition with CC
- DRG 976 HIV with Major Related Condition without CC/MCC
- DRG 977 HIV with or without Other Related Condition
Related conditions
Grouped by AHRQ's Clinical Classifications Software Refined (CCSR), which sorts every diagnosis code into clinically meaningful categories.
B20 is in HIV infection (INF006, its default category), with 10 codes. Others in it:
- B97.35 Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere
- E88.14 HIV-associated lipodystrophy
- O98.711 Human immunodeficiency virus [HIV] disease complicating pregnancy, first trimester
- O98.712 Human immunodeficiency virus [HIV] disease complicating pregnancy, second trimester
- O98.713 Human immunodeficiency virus [HIV] disease complicating pregnancy, third trimester
- O98.719 Human immunodeficiency virus [HIV] disease complicating pregnancy, unspecified trimester
- O98.72 Human immunodeficiency virus [HIV] disease complicating childbirth
- O98.73 Human immunodeficiency virus [HIV] disease complicating the puerperium
Medicare coverage articles listing B20
These 31 Medicare billing and coding articles list B20 as a diagnosis that supports medical necessity for the services they cover. From the CMS Medicare Coverage Database; check your own contractor's article before billing.
- MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing (4 contractors)
- Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy (2 contractors)
- Cosmetic and Reconstructive Surgery (2 contractors)
- Erythropoiesis Stimulating Agents (2 contractors)
- Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (2 contractors)
- Lab: Flow Cytometry (2 contractors)
- Ophthalmic Angiography (Fluorescein and Indocyanine Green) (2 contractors)
- Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography) (2 contractors)
- Pharmacogenomics Testing (2 contractors)
- Routine Foot Care (2 contractors)
And 21 more.
Other codes that refer to B20
Notes on these codes point to B20.
- A50-A64 Excludes2: human immunodeficiency virus [HIV] disease (B20)
- B39 Code First: associated AIDS (B20)
- B97.3 Excludes1: Human immunodeficiency virus [HIV] disease (B20)
- C46 Code First: any human immunodeficiency virus [HIV] disease (B20)
- CH3 Excludes2: human immunodeficiency virus [HIV] disease (B20)
- D59.31 Use Additional Code: Human immunodeficiency virus [HIV] disease (B20)
- D61.81 Excludes1: pancytopenia (due to) (with) human immunodeficiency virus disease (B20.-)
- D80-D89 Excludes2: human immunodeficiency virus [HIV] disease (B20)
- D84.81 Excludes1: human immunodeficiency virus [HIV] disease (B20)
- D89.89 Excludes1: human immunodeficiency virus disease (B20)
- E88.14 Code First: any human immunodeficiency virus [HIV] disease (B20)
- F02 Code First: human immunodeficiency virus [HIV] disease (B20)
- F06.7 Code First: human immunodeficiency virus [HIV] disease (B20)
- G05 Code First: human immunodeficiency virus [HIV] disease (B20)
- I27.21 Code Also: human immunodeficiency virus [HIV] disease (B20)
- I88 Excludes1: human immunodeficiency virus [HIV] disease resulting in generalized lymphadenopathy (B20)
- L04 Excludes1: human immunodeficiency virus [HIV] disease resulting in generalized lymphadenopathy (B20)
- O98.7 Use Additional Code: Acquired immune deficiency syndrome (AIDS) (B20)
- O98.7 Use Additional Code: Symptomatic HIV disease (B20)
- P35-P39 Excludes2: human immunodeficiency virus [HIV] disease (B20)
About the condition
Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.
HIV
HIV stands for human immunodeficiency virus. HIV harms your immune system by destroying a type of white blood cell that helps your body fight infection. This puts you at risk for other infections and diseases.
Read more about hiv on MedlinePlusCode history
Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.
ICD-9-CM equivalent
Legacy crosswalk from the CMS General Equivalence Mappings (last updated 2018).
- 042 Human immunodeficiency virus [HIV] disease