ICD-10 B97.35
Billable / Specific HCC v28: 1 CCHuman immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere
About ICD-10-CM B97.35
ICD-10-CM code B97.35 represents Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere. This is a billable/specific code in the Infectious and Parasitic Diseases chapter (block B97). The 2026 edition of ICD-10-CM B97.35 became effective on October 1, 2025.
Coding Tips for B97.35
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
B97.35 is a CMS-HCC v28 risk-adjustment code (category 1). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
B97.35 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, CC
codes Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for B97.35
Local Coverage Determinations (LCDs) from CMS MACs that list B97.35 as a covered diagnosis.
Showing top 10 of 612 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing B97.35.
4 Aetna
2 Cigna
5 Medicare
3 FL Medicaid
CPT Codes Commonly Billed with B97.35
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 86356 CMS LCD: Billing and Coding: Lab: Flow Cytometry CMS LCD
- 86357 CMS LCD: Billing and Coding: Lab: Flow Cytometry CMS LCD
- 86361 CMS LCD: Billing and Coding: Lab: Flow Cytometry CMS LCD
- 88189 CMS LCD: Billing and Coding: Lab: Flow Cytometry CMS LCD
- 88182 CMS LCD: Billing and Coding: Lab: Flow Cytometry CMS LCD
- 86367 CMS LCD: Billing and Coding: Lab: Flow Cytometry CMS LCD
- 88184 CMS LCD: Billing and Coding: Lab: Flow Cytometry CMS LCD
- 88188 CMS LCD: Billing and Coding: Lab: Flow Cytometry CMS LCD
- 86360 CMS LCD: Billing and Coding: Lab: Flow Cytometry CMS LCD
- 88187 CMS LCD: Billing and Coding: Lab: Flow Cytometry CMS LCD
Convert B97.35 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| B97.35 | 07953 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To B97.35
Other codes in section B95-B97 (Bacterial and viral infectious agents).
ICD-10 B97.35, Billing FAQ
Is ICD-10 code B97.35 billable? +
Yes, B97.35 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does B97.35 affect Medicare Advantage HCC risk adjustment? +
Yes. B97.35 maps to CMS-HCC v28 category 1. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is B97.35 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with B97.35? +
Procedures frequently paired with B97.35 include: 86356, 86357, 86361, 88189, 88182.
What ICD-9 codes does B97.35 map to? +
Per CMS GEMs, B97.35 maps to ICD-9 codes: 07953. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on July 16, 2026.
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