3 Steps Help Handle Hepatitis Case Coding
Published on Mon Mar 27, 2006
You can report NPP services for follow-up care Hepatitis patients require ongoing care--from initial consult through diagnosis and follow-up. Make the most of each coding opportunity along the way with these easy, expert-approved steps. Step 1: Thoroughly Document the Initial Visit Generally, the first service you will report for a potential hepatitis patient is a consult (for example, 99241-99245), during which the gastroenterologist will take steps to confirm the diagnosis. When it's properly documented, you will usually find that this is a high-level service.
-Typically, most first visits with a possible hepatitis patient would involve a high level of decision-making. The doctor must evaluate risk factors, order lab tests and possibly provide counseling,- says Amy Walker, CPC, insurance and billing supervisor at Gastrointestinal Associates in Knoxville, Tenn. -I think the medical decision-making would fall into the moderate-complexity range for most patients. Most visits [properly documented] would probably fall into the 99243-99244 range.-
Example: The gastroenterologist sees a patient at the request of the patient's primary-care physician. The patient complains of severe fatigue and rapid weight loss and shows signs of jaundice.
After performing a comprehensive history and exam with moderate medical decision-making, the physician diagnoses acute hepatitis C without hepatic coma.
The gastroenterologist records his findings and provides a report back to the requesting physician.
For this visit, you should claim 99244 (Office consultation for a new or established patient, which requires ... a comprehensive history; a comprehensive examination; and medical decision-making of moderate complexity) for the initial consultation.
Caution: Be sure you have met all the documentation requirements for a consult before billing the visit as such. If you cannot meet the requirements to report a consult, you will have to code for a lower-paying outpatient E/M service (99201-99215). See -Join With Referring Physicians, or Lose Out on Consults- on page 27 for more information. Step 2: Choose the Right Code for Lab Work One often-requested lab test is 80074 (Acute hepatitis panel) for a hepatitis panel. The panel combines several tests, including the hepatitis B surface antigen (87340), hepatitis C antibody (86803), hepatitis B core IgM antibody (86705), and hepatitis A IgM antibody (86709).
The panel includes all the above individual tests, says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. -I would recommend that you bill the panel code when all the component codes are performed,- he adds.
When to order a panel: CMS gives two indications of when you may provide a hepatitis panel:
1. To detect viral hepatitis infection when there are abnormal liver function test results, with or without signs or symptoms of hepatitis.
2. Prior to and subsequent to liver transplantation. Patients with a negative result may need a repeat panel when the time of [...]
