D89.3

Billable

Immune reconstitution syndrome

HCC Category Mapping

V24HCC 47 — Disorders of Immunity

0.472

ESRDHCC 47 — Disorders of Immunity

0.000

RxHCCHCC 99 — Immunodeficiencies

0.000

What This Code Means

A syndrome that occurs when the immune system rapidly recovers after being suppressed, causing inflammation and tissue damage, often seen in HIV/AIDS patients starting antiretroviral therapy.

Coding Tips

•This code is commonly used in immunocompromised patients, particularly those with HIV starting treatment
•Document the specific manifestations and affected organs for complete clinical picture

Clinical Significance

Immune reconstitution inflammatory syndrome occurs when a recovering immune system mounts an excessive inflammatory response to previously acquired infections or antigens. It is most commonly seen in HIV patients initiating antiretroviral therapy but also occurs after discontinuation of immunosuppressive medications or following stem cell transplantation. The paradoxical worsening despite treatment improvement can be life-threatening, particularly with central nervous system involvement.

Documentation Requirements

✓Documentation must clearly establish the diagnosis of immune reconstitution syndrome, the temporal relationship to immune recovery (initiation of antiretroviral therapy, discontinuation of immunosuppressive drugs, or post-transplant engraftment), and the specific infectious or inflammatory trigger.
✓The provider should document the patient's immune recovery markers (rising CD4 count, decreasing viral load) and the clinical manifestations requiring treatment.

Use Additional Code

code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

Commonly Confused Codes

B20 (Human immunodeficiency virus disease) should be coded as the underlying condition when applicable but does not replace D89.T86.- (Complications of transplanted organs and tissue) may be more appropriate if the clinical picture is graft rejection rather than immune reconstitution. D89.89 (Other specified disorders involving the immune mechanism) is a less specific alternative that should not be used when immune reconstitution syndrome is confirmed.

Code Hierarchy

└D89Other disorders involving the immune mechanism, not elsewhere classified └D89.3Immune reconstitution syndrome

└D89.3Immune reconstitution syndrome