Pathology/Lab Coding Alert

‘V’ codes move to ‘Z’ or ‘F’ codes for screening diagnosis.

If you’re reporting a hepatitis C virus (HCV) screening test for a Medicare beneficiary under the new national screening policy, you’d better be ready for the switch to ICD-10 on Oct. 1 later this year.

That’s because Medicare not only defines the diagnosis code you should use for the procedure (G0472, Hepatitis c antibody screening, for individual at high risk and other covered indication[s]), but also the diagnosis codes.

Use Specific Diagnosis Codes for Medicare HCV Screens

CMS categorizes three scenarios that warrant HCV screening, and provides the following diagnosis coding direction:

• Patients who were born between the years 1945 to 1965, but are not otherwise identified as “high risk” for HCV: “CMS does not appear to specify a diagnosis code to link to G0472 for individuals who are not at high risk, and there is no ICD-9 code specific to screening for HCV,” observes Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians (AAFP) in Kansas City, Mo. “One suggestion would be to use V73.89 (Special screening examination for viral and chlamydial diseases; Other specified viral diseases) under ICD-9, and Z11.59 (Encounter for screening for other viral diseases) under ICD-10,” adds Moore.

• Patients identified as high risk, who receive an initial HCV screening: Report ICD-9 code V69.8 (Other problems related to lifestyle). This ICD-9 code crosswalks to Z72.89 (Other problems related to lifestyle) in ICD-10, which you should use to report an initial high-risk HCV screening beginning Oct. 1.

• Patients identified as high risk who receive a follow-up HCV screening due to continued illicit injection-drug use following the initial negative screen: Report ICD-9 diagnosis codes V69.8 and 304.91 (Unspecified drug dependence, continuous) until Oct. 1. Once ICD-10 goes into effect, switch to reporting ICD-10 codes Z72.89 and F19.20 (Other psychoactive substance dependence, uncomplicated).