ICD-10 Code for HIV Prophylaxis
The ICD-10 code for a patient on antiviral prophylaxis for HIV is Z20.6 (Contact with and [suspected] exposure to human immunodeficiency virus [HIV]).
Primary Coding for HIV Prophylaxis
Z20.6 is the appropriate code when documenting a patient receiving antiretroviral prophylaxis following potential HIV exposure or for ongoing prevention in high-risk individuals 1.
This code applies to both post-exposure prophylaxis (PEP) scenarios where antiretroviral therapy is initiated within 72 hours of exposure and continued for 28 days, and pre-exposure prophylaxis (PrEP) where patients at ongoing risk take daily antiretroviral medication 1.
Additional Relevant Codes
Z79.899 (Other long-term [current] drug therapy) may be used as a secondary code to indicate the patient is on chronic antiretroviral medication, particularly for PrEP users on daily tenofovir disoproxil fumarate/emtricitabine 2, 3.
Z11.4 (Encounter for screening for human immunodeficiency virus [HIV]) should be used for the mandatory quarterly HIV testing required during PrEP monitoring 2, 3.
Clinical Context for Coding
For PrEP patients, the coding reflects ongoing prophylaxis with daily tenofovir disoproxil fumarate/emtricitabine (TDF/FTC), which requires HIV testing every 3 months, STI screening, and creatinine monitoring 2, 3.
For PEP patients, the coding applies during the 28-day treatment course following exposure, with preferred regimens including bictegravir/emtricitabine/tenofovir alafenamide or dolutegravir plus two nucleoside reverse transcriptase inhibitors 1.
The code Z20.6 is appropriate regardless of whether the exposure was sexual, injection drug use-related, or other nonoccupational exposure 1.
Important Coding Caveats
Do not use Z20.6 if the patient has confirmed HIV infection; use B20 (Human immunodeficiency virus [HIV] disease) instead 1.
If PrEP is inadvertently prescribed to someone with undiagnosed acute HIV infection (which can occur with false-negative antibody/antigen testing within 7-10 days of infection), the coding should shift to B20 once diagnosis is confirmed 4.
For pediatric patients receiving prophylaxis, the same Z20.6 code applies, though specific antiretroviral regimens differ by age and weight 1, 5.