A huge new batch of Medicare's National Coverage Determinations (NCD) is now on the books, so you'll need to take a look at the new diagnosis codes that support medical necessity for your hepatitis and fecal-occult blood tests.
An NCD is a national policy statement that grants, limits or excludes Medicare coverage for certain tests. This policy states the circumstances under which a test is considered reasonable and necessary. The latest NCD, Program Memorandum AB-02-110, went into effect on Nov. 25, 2002, and will be implemented beginning Jan. 1, 2003.
"The new national coverage decisions will impact reimbursement for 65 CPT codes which account for approximately 60 percent of laboratory claims, according to the negotiated rulemaking committee that authored the rule," says Laurie Castillo, MA, CPC, CPC-H, CCS-P, member of the national advisory board of the American Academy of Professional Coders (AAPC) and president of
Physician Coding and Compliance Consulting in Manassas, Va. Since gastroenterologists frequently order several common laboratory tests in order to properly diagnose digestive disorders, the NCDs will greatly affect the way you will code in the future. Follow Strict Rules for Acute Hepatitis Panel Gastroenterologists are seeing a growing number of hepatitis patients, which means more diagnostic tests are ordered each day. The acute hepatitis panel (80074) consists of several tests that include the hepatitis B surface antigen (87340), hepatitis C antibody (86803), hepatitis B core antibody and IgM antibody (86705), and hepatitis A antibody and IgM antibody (86709). This panel is used for diagnosis in a patient with symptoms of liver disease or injury. Patients with a negative result may need a repeat panel, when the time of exposure or stage of the disease is unknown.
Medicare lists two indications for the use of this panel. One use is to detect viral hepatitis when there are abnormal liver function test results, with or without signs or symptoms of hepatitis. The test is also indicated prior to and subsequent to liver transplantation. Be aware that once the physician establishes a hepatitis diagnosis, only individual tests are covered.
The Program Memorandum contains a full list of covered diagnosis codes. These codes include the following symptoms and diseases: Hepatitis (070.0-070.9, 573.3) Esophageal varices (456.0-456.21) Liver damage (570, 571.5, 572.0-572.8) 573.3 (Hepatitis, unspecified) Symptoms of fatigue (780.71, 780.79) 782.4 (Jaundice, unspecified, not of newborn) Abdominal problems (789.00-789.09, 789.61) Nutrition and stomach problems (783.0-783.6, 787.01-787.03) Liver transplant (996.82, V72.85) 789.1 (Hepatomegaly) 794.8 (Nonspecific abnormal results of function studies) and 784.69 (Other symbolic dysfunction) 999.3 (Other infection following infusion, injection, transfusion, or vaccination). Fit Proper Diagnosis Codes With Fecal-Occult Blood Test Gastroenterologists use the fecal-occult blood test to detect trace amounts of blood in the stool. They also [...]
