Pathology/Lab Coding Alert

Question: When a physician orders a hepatitis panel to follow the course of treatment for a hepatitis patient, our lab may get denials for the panel. Why isn't the panel covered for a patient with the disease?

Florida Subscriber
 
Answer: CMS gives two indications of medical necessity for a hepatitis panel (80074, Acute hepatitis panel):
 
1. To detect viral hepatitis infection in a patient with abnormal liver function test results, with or without signs or symptoms of hepatitis, and
 
2. Prior to and subsequent to liver transplant.

Also, patients with negative panel results may need a repeat panel when the time of exposure or stage of disease is unknown.
 
Important point: After the physician has established a hepatitis diagnosis, you may report only individual tests, as necessary, rather than the entire panel. In other words, the physician should not repetitively order the entire panel for a single patient when monitoring progress or changes after he has identified the initial specific cause of hepatitis.

 -- Reader Questions and You Be the Coder were prepared with the assistance of R. M. Stainton Jr., MD, president of Doctors- Anatomic Pathology Services in Jonesboro, Ark.