QUESTION:

What is the principal diagnosis in this scenario?

SCENARIO:

A 46-year old male, who is an HIV-infected patient, has a long history of opiate addiction. He started using heroin again. Last year he was admitted for treatment of Pneumocystis carinii pneumonia. Presently, severe depression brought him to the hospital and he was admitted. He and the physician had an extensive discussion about returning to Narcotics Anonymous and also joining an AIDS support group. A prescription for Prozac was given for his depression.

Diagnoses: (1) Severe recurrent depression, (2) heroin addiction, (3) HIV infection

ANSWER:

F33.2 Major depressive disorder, recurrent episode, severe without psychotic features

B20 Human immunodeficiency virus [HIV] disease

F11.20 Opiate dependence, uncomplicated

Comments: Depression, specified as severe, was responsible for the encounter and is sequenced as the reason for the admission or principal diagnosis. The depression was not identified as being opiate-induced and therefore code F11.24, Opioid dependence with opioid-induced mood disorder, is not appropriate. The HIV infection contributed to the patient's depression, but the depression was the reason for the encounter. The patient has a hx of HIV related illness, therefore the B20 is the appropriate code here.