Gastroenterology Coding Alert

Question: Our GI just saw a Medicare patient and advised her to undertake a hepatitis C screening test. Does Medicare recognize the screening? What ICD-9 and ICD-10 codes can I report for hepatitis screening testing? 

Arkansas Subscriber

Answer: Yes. According to Medicare, hepatitis screening is proven and medically necessary for one-time screening for HCV infection for adults born during 1945-1965, whether or not risk factors have been identified. Additionally, hepatitis screening for “at risk” persons for acute and chronic infections is proven and medically necessary for following symptoms among many others:

• Persons with a history of sexually transmitted infections (STI) 
• Persons with risky sexual behavior 
• Human Immunodeficiency Virus (HIV) infected persons 
• Persons having usage history of injected/non-injected illicit drugs 
• Persons that belong to or have traveled to regions/countries with high or intermediate prevalence of hepatitis A virus (HAV) or hepatitis B virus (HBV) infection 
• All pregnant women including those with a sexually transmitted infection (STI)

Medicare has assigned the Healthcare Common Procedure Coding System (HCPCS) code G0472 (Hepatitis C antibody screening, for individual at high risk and other covered indication[s]).

If the screening is for a patient with no increased risk factors or medical complications such as high-risk pregnancy, you can use among V73.89 (Special screening examination for other specified viral diseases), V73.99 (Special screening examination for unspecified viral disease), V75.9 (Screening examination for unspecified infectious disease), etc.

If the patient reports increased risk factors, such as past or present injection drug use or multiple sexual partners, you can list V73.89 as the primary code and additionally report V69.8 (Other problems related to lifestyle) or V69.2 (High-risk sexual behavior) as the secondary diagnosis. 

Under ICD-10, you can justify the testing with Z11.59 (Encounter for screening for other viral diseases) and Z11.9 (Encounter for screening for infectious and parasitic diseases, unspecified)