2017 Billing and Coding Updates on Hepatitis B Screening

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2017 Billing and Coding Updates on Hepatitis B
Screening
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Chronic hepatitis B virus (HBV) infection is the
leading cause of liver-related morbidity and
mortality. Hepatitis screening allows physicians
to confirm a diagnosis before symptoms develop
and offer a safe and effective therapy. Medical
billing and coding services for hepatitis
screening must be based on the guidelines
provided by Medicare or other concerned insurance
companies. Based on the updated recommendations
for hepatitis B virus (HBV) screening from U.S.
Preventive Services Task Force, Medicare has
added Part A and Part B coverage for HBV
screening, effective September 28, 2016.
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Conditions for Medicare Coverage

• Medicare will cover screening for HBV infection,
  only if
• The screening is performed using the appropriate
  FDA-approved laboratory test, used consistent
  with FDA-approved labeling and in compliance with
  the Clinical Laboratory Improvement Act
  regulations.
• The screening is ordered by the patients primary
  care physician or practitioner in the primary
  care setting.
• The patient is either an asymptomatic,
  non-pregnant adolescent/adult at high risk for
  HBV infection, or pregnant.
• Non-pregnant adolescents/adults at high risk for
  HBV infection can receive one screening annually.
• Pregnant women should be screened at the first
  prenatal visit (of each pregnancy) and then
  rescreened at the time of delivery for those with
  new or continuing risk factors.

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Medical Codes for HBV Screening HCPCS G0499
Hepatitis B screening in non-pregnant, high risk
individual includes hepatitis B surface antigen
(HBsAg) followed by a neutralizing confirmatory
test for initially reactive results, and
antibodies to HBsAg (anti-hbs) and hepatitis B
core antigen (anti-hbc)
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• CPT
• 86704 Hepatitis B core antibody (HBcAb) total
• 87340 - Infectious agent antigen detection by
  enzyme immunoassay technique, qualitative or
  semi-quantitative, multiple step method
  hepatitis B surface antigen (HBsAg)
• 87341 - Infectious agent antigen detection by
  enzyme immunoassay technique, qualitative or
  semi-quantitative, multiple step method
  hepatitis B surface antigen (HBsAg)
  neutralization

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ICD-10 CMS will allow coverage for G0499 for HBV
screening only when services are reported with
both of the following diagnosis codes denoting
high risk

• Z11.59 Encounter for screening for other viral
  disease
• Z72.89 Other problems related to lifestyle

CMS will allow coverage for G0499 for subsequent
visits when reported with Z11.59 and one of the
following high-risk codes, as appropriate

• F11.10 F11.99
• F13.10 F13.99
• F14.10 F14.99
• F15.10 F15.99
• Z20.2
• Z20.5
• Z72.52
• Z72.53

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• For HBV screening in pregnant women, use the
  right CPT code with Z11.59 and one of the
  following
• Z34.00 Encounter for supervision of normal first
  pregnancy, unspecified trimester
• Z34.80 Encounter for supervision of other normal
  pregnancy, unspecified trimester
• Z34.90 Encounter for supervision of normal
  pregnancy, unspecified, unspecified trimester
• O09.90 Supervision of high risk pregnancy,
  unspecified, unspecified trimester

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• For HBV screening in pregnant women at high risk,
  the appropriate CPT code can be reported with
  Z11.59, Z72.89, and one of the following
  ICD-10-CM codes, as appropriate
• Z34.00 Z34.03
• Z34.80 Z34.83
• Z34.90 Z34.93
• O09.90 O09.93

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Physicians can consider outsourcing their complex
HBV medical documentation and billing tasks to
reliable medical billing companies. Professional
companies provide services of AAPC-certified
professional coders, who are up-to-date with the
current ICD-10 and CPT codes as well as the
applicable modifiers based on the factors
involved.
Thank You!
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