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ICD-10 Guide
ICD-10 CodesR75

R75

Inconclusive laboratory evidence of human immunodeficiency virus [HIV]

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 R75 is a billable code used to indicate a diagnosis of inconclusive laboratory evidence of human immunodeficiency virus [hiv].

Key Diagnostic Point:

The ICD-10 code R75 is designated for cases where there is inconclusive laboratory evidence of human immunodeficiency virus (HIV). This category is primarily used when diagnostic tests for HIV yield ambiguous results, which may necessitate further testing or clinical evaluation to confirm the presence or absence of the virus. Conditions covered under this code include situations where initial serological tests indicate potential exposure to HIV but do not provide definitive evidence of infection. It is crucial for healthcare providers to recognize the importance of follow-up testing and patient monitoring in these cases to ensure accurate diagnosis and treatment planning.

  • The clinical significance of R75 lies in its role in identifying patients who may be at risk for HIV infection but do not yet meet the criteria for a confirmed diagnosis. This code is particularly relevant in settings where patients may present with symptoms suggestive of acute HIV infection or where risk factors are present, but laboratory results do not provide clear guidance. Usage guidelines for R75 emphasize the need for thorough clinical assessment and patient education regarding the implications of inconclusive results, as well as the importance of retesting and counseling to address potential risks and preventive measures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in laboratory testing methods
  • Need for follow-up testing
  • Potential for misinterpretation of results

Audit Risk Factors

  • Inadequate documentation of follow-up plans
  • Failure to provide patient education
  • Misuse of inconclusive results in billing

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Primary Care

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical impact of the R75 code is significant, as it highlights the need for ongoing monitoring and follow-up for patients with inconclusive HIV test results. This can lead to improved patient outcomes through timely interventions and preventive measures. Additionally, the use of R75 in clinical practice can enhance population health initiatives by identifying individuals at risk for HIV and facilitating access to appropriate care and resources. As healthcare trends continue to evolve, the emphasis on early detection and management of HIV will be critical in reducing transmission rates and improving overall public health.
From an administrative perspective, accurate coding and billing for R75 can influence quality measures and healthcare metrics related to HIV care. Proper documentation and follow-up can contribute to better tracking of patient outcomes and the effectiveness of interventions. Furthermore, as healthcare systems increasingly focus on value-based care, understanding the implications of inconclusive HIV test results and the appropriate use of R75 will be essential for aligning clinical practices with broader health goals.

ICD-9 vs ICD-10

The clinical impact of the R75 code is significant, as it highlights the need for ongoing monitoring and follow-up for patients with inconclusive HIV test results. This can lead to improved patient outcomes through timely interventions and preventive measures. Additionally, the use of R75 in clinical practice can enhance population health initiatives by identifying individuals at risk for HIV and facilitating access to appropriate care and resources. As healthcare trends continue to evolve, the emphasis on early detection and management of HIV will be critical in reducing transmission rates and improving overall public health. From an administrative perspective, accurate coding and billing for R75 can influence quality measures and healthcare metrics related to HIV care. Proper documentation and follow-up can contribute to better tracking of patient outcomes and the effectiveness of interventions. Furthermore, as healthcare systems increasingly focus on value-based care, understanding the implications of inconclusive HIV test results and...

Reimbursement & Billing Impact

billing for R75 can influence quality measures and healthcare metrics related to HIV care. Proper documentation and follow-up can contribute to better tracking of patient outcomes and the effectiveness of interventions. Furthermore, as healthcare systems increasingly focus on value-based care, understanding the implications of inconclusive HIV test results and the appropriate use of R75 will be essential for aligning clinical practices with broader health goals.

Resources

Clinical References

  • •
    Official ICD-10 Guidelines for R75

Coding & Billing References

  • •
    Official ICD-10 Guidelines for R75

Frequently Asked Questions

What conditions are included in R75?

R75 includes cases where laboratory tests for HIV are inconclusive, indicating potential exposure but not confirming infection. This may involve ambiguous serological test results or indeterminate results that require further evaluation.

When should I use R75 codes?

R75 should be used when a patient presents with inconclusive laboratory evidence of HIV, necessitating further testing or clinical evaluation. It is important to document the context and rationale for using this code.

What documentation is required for R75?

Documentation for R75 should include the results of laboratory tests, clinical findings, risk factors for HIV, and a plan for follow-up testing or patient management to ensure comprehensive care.