BASIC (09-08)

DI 24595.015 Diagnosis Coding for Human Immunodeficiency Virus (HIV) Infection

A. Procedure for coding symptomatic HIV infection

Symptomatic HIV infection means that an individual has HIV infection which is accompanied by signs, symptoms, or disease manifestations which could reasonably be expected to be related to HIV infection.

Use 0430 as the primary diagnosis code when symptomatic HIV infection is the basis for allowance. The following must apply:

  • meets or medically equals the HIV listing;

  • medical-vocational allowance; or

  • functional equals.

Follow DI 26510.015G.4. for the secondary diagnosis codes to use when symptomatic HIV infection is the primary diagnosis.

REMEMBER: Do not use code 0430 as the primary diagnosis code when the basis for the allowance is not HIV infection even if the claimant has symptomatic HIV infection. This includes cases in which the allowance is based on an unrelated impairment or in which an HIV-infected person has an impairment(s) that meets or equals another listing. In such cases, follow the rules in DI 26510.015C. to determine whether code 0430 should be the secondary diagnosis code.

For symptomatic HIV infection cases that are denied, that is, as medical-vocational decisions for adults or functional equals decisions for children, follow DI 26510.015C. to determine whether to use code 0430 as the primary or secondary diagnosis.

B. Procedure for coding asymptomatic HIV infection

Asymptomatic HIV infection means that an individual has HIV infection but has not yet experienced signs, symptoms, or disease manifestations which could reasonably be expected to be related to HIV infection.

Use 0440 as the diagnosis code for asymptomatic HIV infection. Follow DI 26510.015C. to determine whether code 0440 should be the primary or secondary diagnosis code or if the impairment is of lesser significance and need not be coded. If a case involving asymptomatic HIV infection is allowed based on the presence of another impairment, the primary diagnosis code must be the code for the other impairment.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0424595015
DI 24595.015 - Diagnosis Coding for Human Immunodeficiency Virus (HIV) Infection - 09/08/2008
Batch run: 01/27/2009
Rev:09/08/2008