Pathology/Lab Coding Alert

Grasp guidelines for new liver-disease MAAA code.

Your lab’s hepatitis C virus (HCV) testing involves many different procedures and codes for diagnosis or treatment monitoring, but CPT^® 2019 adds one more code to the mix that you need to know.

There’s help: Read on for guidance on the Multianalyte Assays with Algorithmic Analysis (MAAA) test described by new CPT^® 2019 code 81596 (Infectious disease, chronic hepatitis C virus (HCV) infection, six biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, and haptoglobin) utilizing serum, prognostic algorithm reported as scores for fibrosis and necroinflammatory activity in liver).

Distinguish Fibrosis MAAA Codes

With the addition of 81596, CPT^® 2019 deletes administrative MAAA code 0001M (Infectious disease, hcv, six biochemical assays (alt, a2-macroglobulin, apolipoprotein a-1, total bilirubin, ggt, and haptoglobin) utilizing serum, prognostic algorithm reported as scores for fibrosis and necroinflammatory activity in liver).

New code 81596 replaces deleted code 0001M to report proprietary tests HCV FibroSURE™, and FibroTest™, by BioPredictive.

Notice: CPT^® 2019 doesn’t change the following two administrative codes for similar liver-disease MAAA tests:

• 0002M (Liver disease, ten biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, haptoglobin, AST, glucose, total cholesterol and triglycerides) utilizing serum, prognostic algorithm reported as quantitative scores for fibrosis, steatosis and alcoholic steatohepatitis (ASH))
• 0003M (… steatosis and nonalcoholic steatohepatitis (NASH)).

Method: The 81596 test uses a serum specimen to assay six biochemical liver-function markers, then uses a proprietary algorithm to evaluate the test results along with patient age and sex data. The MAAA report provides a measure of liver fibrosis and inflammatory activity corresponding to the Metavir scoring system, which correlates to the standard liver-biopsy report for stage (fibrosis) and grade (necroinflammatory activity).

The six liver function markers evaluated in the test are ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, and haptoglobin.

“You should never use an additional code to report a component lab test, such as 84460 (Transferase; alanine amino (ALT) (SGPT)), when you’re reporting a MAAA code,” says William Dettwyler, MT AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

That’s why the Correct Coding Initiative (CCI) edits bundle 81596 with the following codes:

• 82172 (Apolipoprotein, each)
• 82977 (Glutamyltransferase, gamma (GGT))
• 83010 (Haptoglobin; quantitative)
• 83012 (Haptoglobin; phenotypes)
• 84460 (Transferase; alanine amino (ALT) (SGPT)).

In fact, CCI lists most of these edit pairs with a modifier indicator of “0,” meaning that you should never unbundle these codes using a modifier such as 59 (Distinct procedural service). Only the 81596/82172 pair has a modifier indicator of “1,” because appropriate documentation and modifier may allow you to report these codes together when the 82172 lab assay involves a different apolipoprotein than the apolipoprotein A-1 included in the MAAA test.

Learn Test and Coverage Indicators

Clinicians use the 81596 test to assess liver status (fibrosis and necroinflammatory activity) in patients already diagnosed with HCV infection in the following circumstances:

• Following HCV diagnosis to evaluate liver status
• Baseline evaluation prior to HCV treatment
• Assessment following HCV treatment
• Noninvasive assessment for patients at increased risk for liver-biopsy complications.

Several agencies have issued hepatitis C testing guidelines that indicate the validity of certain “noninvasive” tests for assessing liver status, invoking some studies that evaluated FibroTest™. The agencies include the American Association for the Study of Liver Disease (AASLD)/ Infectious Diseases Society of America (IDSA), Department of Veterans Affairs (VA) and the National Viral Hepatitis Program, and the United States Preventive Services Task Force (USPSTF).

Coverage questionable: Despite those studies and guidelines, Medicare and most other payers still consider FibroTest™ “investigational,” meaning that payers won’t generally cover the cost of the test when clinicians order the MAAA procedure to evaluate and monitor patients with HCV infection and chronic liver disease. Consult your payer for instructions regarding coverage for this test.

81569 Not for HCV Diagnosis

Although clinicians don’t order 81596 to diagnose HCV infection, you should be aware of other tests your lab might perform for HCV diagnosis.

When clinicians order lab test(s) to determine if a patient has been infected with HCV, or for follow-up testing, you need to turn to one or more of these codes:

• 86803 (Hepatitis C antibody). A positive antibody test indicates a likely past or current HCV infection, but requires subsequent confirmatory testing.
• 86804 (… confirmatory test (e.g., immunoblot)). Report this code for a confirmatory test following a positive 86803 test.
• 87520 (Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, direct probe technique). Persistence of HCV RNA more than six months beyond initial infection may indicate chronic disease.
• 87521 (… hepatitis C, amplified probe technique, includes reverse transcription when performed). Positive results on this test, possibly accompanied by elevated blood levels of alanine aminotransferase (ALT), indicate active infection.
• 87522 (… hepatitis C, quantification, includes reverse transcription when performed) Clinicians may order this test to monitor HCV-infection treatment.
• 87902 (Infectious agent genotype analysis by nucleic acid (DNA or RNA); Hepatitis C virus). Clinicians may order this test for cases of confirmed HCV infection, because genotype impacts possible treatment regimens.

Medicare screening: If the lab performs a screening test for HCV infection, you should report the test as G0472 (Hepatitis C antibody screening, for individual at high risk and other covered indication(s)) regardless of the lab method used.

Medicare will cover HCV screening one time for patients born during one of the years 1945 through 1965. Medicare also covers screening tests for patients at high risk for HCV infection, which includes the following situations:

• Patients who have had a blood transfusion prior to the year 1992
• Patients with a current or past history of illicit injection drug use.