Pathology/Lab Coding Alert

Acute/chronic distinction will lead in ICD-10.

You’ll have the same number of codes and nearly identical definitions for reporting hepatitis C once ICD-10 goes into effect, but you need to learn one important organizational change to be able to find them.

Make sure you read “Check Out This CMS Update” on page 54 to learn more about the new ICD-10 implementation deadline. 

Hepatic Coma is Secondary for ICD-10

Under ICD-9, you start with hepatic coma status to zero in on hepatitis C codes. The fourth digit is the key, as follows:

• 070.4x — Other specified viral hepatitis with hepatic coma
• 070.5x — Other specified viral hepatitis without mention of hepatic coma
• 070.7x — Unspecified viral hepatitis C.

Using ICD-10, the chronic/acute status leads your hepatitis C code choices, as follows:

• B17.1_ — Acute hepatitis C
• B18.2 — Chronic viral hepatitis C
• B19.2_ — Unspecified viral hepatitis C.

Here are a couple of crosswalks, for example:

• 070.41 (Acute hepatitis C with hepatic coma) crosswalks to B17.11 (Acute hepatitis C with hepatic coma).
• 070.44 (Chronic hepatitis C with hepatic coma) and 070.54 (Chronic hepatitis C without mention of hepatic coma) both crosswalk to B18.2. For chronic hepatitis C, there’s no hepatic coma distinction under ICD-10
• 070.51 (Acute hepatitis C without mention of hepatic coma) crosswalks to B17.10 (Acute hepatitis C without hepatic coma).

Coder tip: ICD-9 definitions use the phrase “without mention of hepatic coma,” which allows you to use the codes if hepatic coma isn’t mentioned in the medical record. ICD-10 uses the phrase “without hepatic coma,” but lists “hepatitis C NOS” under the code, meaning that you can also use the ICD-10 code if hepatic coma isn’t mentioned in the medical record.