HIV: A MEDICAL CODER MAKES A STARTLING STATEMENT

Jon Rappoport

Is this yet one more giant AIDS scandal?

A diagnosis of AIDS without documentation of an HIV test? A diagnosis of AIDS based on some OTHER disease arbitrarily called “AIDS-related?”

A medical coder (name withheld) has presented an extraordinary statement to me. I hope it will stimulate other coders to come forward and report their findings.

In the coder’s following text, you will read several key claims. They strongly suggest that patients can be wrongly diagnosed with AIDS, even assuming the science behind HIV is correct (a science many independent researchers reject).

This coder states that diagnoses of AIDS, as they are passed down to coders by doctors, can leave a shocking evidentiary gap, a hole which coders are supposed to ignore.

 

The coder writes:

“The job of the medical coder is to take what the doctor documents on the patient’s medical record and translate the diagnosis(es) and procedures done into codes. These codes are submitted to the payor for reimbursement. ie: private insurance, government insurance, etc.”

“The coder must only code what gets documented by the medical provider. If documentation is unclear, the coder must query the provider for further information, and the medical record gets updated or amended. If something is not documented, it CANNOT be coded.”

“The coder has specific coding conventions and guidelines that are to be followed and they are given and broken down in the guidelines section of the coding books. This allows easy reference for the coder.”

“The guidelines are broken down by chapter in the code book, and offer specific coding rules for each chapter listed.”

“When a patient presents to the doctor, the reason for them coming to the doctor gets documented. The doctor documents exactly what they have done to the patient and any diagnosis(es), and procedures performed.”

“The chapter guidelines state very clearly that when the patient presents to the doctor with symptoms of an AIDS-related illness and the doctor diagnoses the patient with an AIDS-related illness, the patient will be coded with B20, AIDS, and then followed by the code for the AIDS-related illness documented.”

“Here is the exact guideline right out of the coding book:”

 

“’Code only confirmed cases

Code only confirmed cases of HIV infection/illness. This is an exception to the hospital inpatient guideline Section II, H.

In this context, “confirmation” does not require documentation of positive serology [test] or culture for HIV; the provider’s diagnostic statement that the patient is HIV positive, or has an HIV-related illness is sufficient’.”

“If a patient presents to the doctor office with symptoms of an AIDS-related illness, and they have no idea they have AIDS, and the doctor diagnoses them with an AIDS-related illness, we are safe to assume and code the patient with having AIDS. We are told that there are several AIDS-related illnesses that can be assumed to be caused by AIDS.”

“Once the patient presents and is confirmed to have an AIDS-related illness it is assumed and coded as AIDS forever on their medical record. No serology/culture test is needed. The assumption of the AIDS-related illness is sufficient.”

This medical coder is asserting that, according to official guidelines, he must list a patient as having AIDS because the doctor says so. The coder does not need to see evidence of a positive HIV test.

Worse yet, according to the coder, a patient can be diagnosed with AIDS merely because he has a so-called “AIDS-related disease.” No HIV test required.

The CDC has, in the past, assembled a long catalog of such “AIDS-related” diseases and infections. BUT ALL OF THEM are diagnosed routinely, in the population, and not called AIDS-related.

If you’re beginning to think an AIDS diagnosis can be entirely arbitrary, that is what this coder is implying.

Here is partial CDC list of these “AIDS-related” diseases: “Lymphoma, multiple forms; Tuberculosis (TB); Candidiasis of bronchi, trachea, esophagus, or lungs; Invasive cervical cancer; Coccidioidomycosis; Cryptococcosis; Cryptosporidiosis, chronic intestinal (greater than one month’s duration); Cytomegalovirus diseases (particularly retinitis) (CMV); Herpes simplex (HSV) [under certain conditions]…; Histoplasmosis; Isosporiasis, chronic intestinal (greater than one month’s duration).”

 

There are more.

Again, the coder is stating that a patient can be coded with AIDS, forever, merely because a doctor diagnoses one of the “related” diseases, with no evidence of a positive HIV test.

I hope other medical coders come forward with their findings and reports.