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ICD-10 Guide
ICD-10 CodesZ11.4

Z11.4

Encounter for screening for human immunodeficiency virus [HIV]

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/12/2025

Code Description

ICD-10 Z11.4 is a billable code used to indicate a diagnosis of encounter for screening for human immunodeficiency virus [hiv].

Key Diagnostic Point:

Z11.4 is used to indicate an encounter for screening for HIV, a critical preventive measure in healthcare. This code is essential for identifying individuals at risk for HIV, facilitating early detection and treatment, which can significantly improve health outcomes. Factors influencing health status include socioeconomic status, access to healthcare, and education about HIV transmission and prevention. Social determinants such as housing stability, employment, and community support systems play a vital role in an individual's likelihood of being screened. Preventive care through regular screenings can reduce the incidence of HIV and its complications, making this code crucial for public health initiatives. Documentation must reflect the patient's risk factors, the rationale for screening, and any relevant social determinants that may affect their health status.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for thorough documentation of risk factors
  • Understanding of social determinants of health
  • Variability in payer requirements for preventive services
  • Potential for co-morbid conditions affecting coding

Audit Risk Factors

  • Inadequate documentation of risk factors
  • Failure to link screening to appropriate clinical scenarios
  • Misunderstanding of payer guidelines for preventive services
  • Incorrect sequencing of codes

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Document patient history, risk factors, and rationale for screening. Include any counseling provided.

Common Clinical Scenarios

Routine checkups where HIV screening is recommended based on risk factors.

Billing Considerations

Consider social determinants such as housing, employment, and education that may influence the patient's health status.

Public Health

Documentation Requirements

Population-level data collection, surveillance documentation, and reporting of screening outcomes.

Common Clinical Scenarios

Community health initiatives aimed at increasing HIV screening rates.

Billing Considerations

Focus on tracking health disparities and outcomes related to social determinants.

Coding Guidelines

Inclusion Criteria

Use Z11.4 When
  • Z codes should be used when the encounter is specifically for screening purposes
  • They should be sequenced appropriately, often as secondary codes following a primary diagnosis
  • Payer requirements may vary, so it's essential to verify coverage for preventive services

Exclusion Criteria

Do NOT use Z11.4 When
No specific exclusions found.

Related CPT Codes

86701CPT Code

HIV-1 antibody test

Clinical Scenario

Used during an encounter coded with Z11.4 for HIV screening.

Documentation Requirements

Document the reason for the test and any counseling provided.

Specialty Considerations

Primary care providers should ensure that the test is linked to the screening encounter.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding encounters for HIV screening, improving data collection and public health reporting.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding encounters for HIV screening, improving data collection and public health reporting.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding encounters for HIV screening, improving data collection and public health reporting.

Resources

Clinical References

  • •
    CDC HIV Screening Recommendations

Coding & Billing References

  • •
    CDC HIV Screening Recommendations

Frequently Asked Questions

When should Z11.4 be used?

Z11.4 should be used when a patient is screened for HIV as part of preventive care, particularly for those at higher risk. Documentation must support the need for screening based on risk factors and social determinants.