Learn What Every Coder Needs to Know for Coding Hepatitis
Here’s the difference between alcoholic hepatitis and hepatitis C. As hepatitis diagnoses become increasingly common in gastroenterology practices, you must stay sharp on ICD-10-CM coding guidelines, documentation requirements, and how to maximize compliant reimbursement. Whether it’s alcoholic hepatitis or hepatitis C, understanding the differences in code structure, associated conditions, and documentation cues can make or break your claims. Alcoholic Hepatitis vs. Hepatitis C: What’s the Difference? The distinction between alcoholic hepatitis and hepatitis C is crucial for diagnosis, treatment, and diagnosis coding. Here's a clear breakdown of the key differences: Cause Alcoholic hepatitis is caused by long-term, excessive alcohol consumption; liver inflammation results directly from toxic effects of alcohol and its metabolites (e.g., acetaldehyde). Meanwhile, hepatitis C is caused by infection with the hepatitis C virus (HCV), transmitted via blood-to-blood contact (e.g., intravenous [IV] drug use, blood transfusions before 1992, or unsafe medical practices). Disease Type Alcoholic hepatitis is non-infectious, not contagious, and often part of alcohol-related liver disease (ALD) spectrum, which may include fatty liver, alcoholic hepatitis, and cirrhosis. Hepatitis C is an infectious viral disease, contagious, and can become chronic in 70 to 85 percent of cases if untreated. Diagnostic Clues For alcoholic hepatitis, the patient may have a history of heavy alcohol use. Symptoms may include jaundice, abdominal pain, fever, nausea, and malaise. The labs may include elevated aspartate aminotransferase (AST)/alanine aminotransferase (ALT) (usually AST > ALT, often in a 2:1 ratio) as well as elevated bilirubin. Patients who have hepatitis C may be asymptomatic for years. Symptoms (if any) may include fatigue, joint pain, dark urine, and jaundice. The labs will show positive HCV antibody and HCV RNA (confirm active infection) as well as elevated ALT. Treatment Treatment for alcoholic hepatitis includes stopping alcohol use immediately. Patients may use corticosteroids or nutritional support in severe cases. The gastroenterologist may treat complications like ascites or hepatic encephalopathy. Meanwhile, patients with hepatitis C may be treated with direct-acting antiviral (DAA) medications. Many patients are cured within eight to 12 weeks of oral therapy. The patient will need to have regular follow-up to assess for fibrosis or cirrhosis. Understand How to Report Hepatitis in ICD-10-CM If you’re working on coding, clinical documentation improvement (CDI), or billing, always check that the underlying cause is clearly documented — that’s the key to selecting the right ICD-10-CM code. Alcoholic Hepatitis In ICD-10-CM, the base code K70.1- (Alcoholic hepatitis) is further expanded to reflect the presence or absence of ascites: Why this matters: The presence of ascites typically signals disease progression, and including it in the coding gives payers a more accurate clinical picture — and may impact medical necessity determinations. Documentation tips: To code K70.10 or K70.11 correctly, look for signs/symptoms (fever, malaise, nausea, hepatic tenderness), physical findings (hepatosplenomegaly, peripheral edema, abdominal dullness [suggestive of ascites], tachycardia, and tachypnea), and imaging or lab findings (liver function tests, complete blood count [CBC], abdominal ultrasound for cirrhosis or ascites). Don’t forget: Report an additional ICD-10 code to indicate alcohol use: Exclusion notes: Make sure to rule out other conditions such as: Hepatitis C When coding for hepatitis C, ICD-10-CM offers precise options. It’s critical for the provider to document: Common ICD-10-CM codes for hepatitis C include: Pro tip: Use B18.2 for patients receiving long-term antiviral therapy or regular lab monitoring after diagnosis. Report Consultation and E/M Coding for Hepatitis The initial consultation for hepatitis, especially hepatitis C, is often a high-level evaluation and management (E/M) service due to the complexity of the evaluation. The physician typically: Example: A patient with fatigue, weight loss, and jaundice is referred to a gastroenterologist. After a 45-minute comprehensive history, physical exam, and moderate-complexity medical decision making (MDM) office visit, the physician diagnoses acute hepatitis C. Code this as: Learn How to Code NPPs in Hepatitis Follow-Up After diagnosis, many practices rely on nonphysician practitioners (NPPs) for follow-up care. NPPs can: For example, if an NPP sees a hepatitis C patient for lab review and follow-up and performs a 20-minute visit with low-complexity MDM, you should report 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.) with B18.2. Takeaways ICD-10-CM coding for hepatitis requires attention to clinical detail, thorough documentation, and smart use of modifier and lab code guidance. By understanding the nuances of both alcoholic and viral hepatitis coding, you’ll support accurate billing and stronger reimbursement — all while staying compliant. Suzanne Burmeister, BA, MPhil, Medical Writer and Editor
