Gastroenterology Coding Alert

Injection instruction usually a low-level E/M service While your gastroenterologist must reach a hepatitis C diagnosis, most non-physician practitioners (NPPs) are qualified to take on the post-diagnosis visits.  And if an NPP can handle your hepatitis patients' follow-up visits, this will free your gastroenterologist up to see other patients - which will help the office's bottom line.

Benefit:  Follow-up care for most hepatitis C patients is very detailed and involves regular office visits for six to 12 months and "lots of counseling and education," says Amy Walker, CPC, CCP, insurance supervisor at Gastrointestinal Associates in Knoxville, Tenn.

Join us for a quick look at the basics of hepatitis C coding, from diagnosis to follow-up visits. We'll also examine a couple of scenarios involving hepatitis care, and get some expert input on the subject from two experienced hepatitis coders. Consult Usually Nets Hepatitis Diagnosis The first step in hepatitis C treatment is diagnosis. The gastroenterologist typically discovers hepatitis C in a patient during a consultation.

"This consult is usually a higher level of service, since the gastroenterologist must evaluate risk factors, do extensive lab work, and counseling," says Walker.

Hepatitis candidates: The symptoms of hepatitis C patients may vary, but most "complain of fatigue, loss of weight, or jaundice," says Mary Garner, CPC, CCP, a coder with a lot of experience coding hepatitis C patients at Gastrointestinal Associates in Knoxville, Tenn.

People who have contracted hepatitis may also have used IV drugs in the past (or had relationships with IV drug users), or had a previous blood transfusion.

Listed below are some of the acceptable ICD-9 codes for hepatitis patients:
   070.51 (Acute hepatitis C without mention of hepatic coma)
   070.54 (Chronic hepatitis C without mention of hepatic coma)
   V02.62 (Hepatitis C carrier)

You should attach an ICD-9 code that best reflects the patient's hepatitis C on all her claims, starting with the initial consultation.
 
Example: Let's say a patient reports for a consultation and tells the gastro she has severe fatigue, and has lost several pounds in the past two days. After performing a comprehensive history and exam with moderate medical decision making, the gastroenterologist diagnoses acute hepatitis C without hepatic coma.On the claim, you should:
   report 99244 (Office consultation for a new or established patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity) for the consultation.
   attach ICD-9 code 070.51 to 99244 to show the consult level was justified because of the diagnosis. NPP Can be Vital to Hepatitis Follow-Up Care Once the physician diagnoses hepatitis, an NPP is qualified to perform a lot of the duties involved in follow-up care, such as adjusting medications; ordering lab tests; and counseling and educating patients.

"The NPP usually takes over visits once [a hepatitis] diagnosis [...]