LCD for Viral Hepatitis Serology Tests

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1 LCD for Viral Hepatitis Serology Tests Applicable CPT Code(s): Antibody; Hepatitis, Delta Agent Hepatitis B Core Antibody (HBcAb); Total Hepatitis B Core Antibody (HBcAb); IgM Antibody Hepatitis B Surface Antibody (HBsAb) Hepatitis Be Antibody (HBeAb) Hepatitis A Antibody (HAAb); Total Hepatitis A Antibody (HAAb); IgM Antibody Hepatitis C Antibody; Hepatitis C Antibody; Confirmatory Test (EG, Immunoblot) Infectious Agent Antigen Detection by Enzyme Immunoassay Hepatitis B Surface Antigen (HBsAg) Infectious Agent Antigen Detection by Enzyme Immunoassay Hepatitis B Surface Antigen (HBsAg) neutralization Infectious Agent Antigen Detection by Enzyme Immunoassay Hepatitis Be Antigen (HBeAg) Infectious Agent Antigen Detection by Enzyme Immunoassay Hepatitis, Delta Agent ICD-9 Codes that Support Medical Necessity: Code Description 042 HUMAN IMMUNODEFICIENCY VIRUS (HIV) DISEASE VIRAL HEPATITIS A WITH HEPATIC VIRAL HEPATITIS A WITHOUT HEPATIC VIRAL HEPATITIS B WITH HEPATIC ACUTE OR UNSPECIFIED WITHOUT HEPATITIS DELTA VIRAL HEPATITIS B WITH HEPATIC ACUTE OR UNSPECIFIED WITH HEPATITIS DELTA CHRONIC VIRAL HEPATITIS B WITH HEPATIC WITHOUT HEPATITIS DELTA CHRONIC VIRAL HEPATITIS B WITH HEPATIC WITH HEPATITIS DELTA VIRAL HEPATITIS B WITHOUT HEPATIC ACUTE OR UNSPECIFIED WITHOUT HEPATITIS DELTA

2 VIRAL HEPATITIS B WITHOUT HEPATIC ACUTE OR UNSPECIFIED WITH HEPATITIS DELTA CHRONIC VIRAL HEPATITIS B WITHOUT HEPATIC WITHOUT HEPATITIS DELTA CHRONIC VIRAL HEPATITIS B WITHOUT HEPATIC WITH HEPATITIS DELTA ACUTE HEPATITIS C WITH HEPATIC HEPATITIS DELTA WITHOUT ACTIVE HEPATITIS B DISEASE WITH HEPATIC HEPATITIS DELTA WITH HEPATITIS B CARRIER STATE HEPATITIS E WITH HEPATIC CHRONIC HEPATITIS C WITH HEPATIC OTHER SPECIFIED VIRAL HEPATITIS WITH HEPATIC ACUTE HEPATITIS C WITHOUT MENTION OF HEPATIC HEPATITIS DELTA WITHOUT ACTIVE HEPATITIS B DISEASE OR HEPATIC HEPATITIS E WITHOUT HEPATIC CHRONIC HEPATITIS C WITHOUT HEPATIC OTHER SPECIFIED VIRAL HEPATITIS WITHOUT HEPATIC UNSPECIFIED VIRAL HEPATITIS WITH HEPATIC UNSPECIFIED VIRAL HEPATITIS C WITHOUT HEPATIC UNSPECIFIED VIRAL HEPATITIS C WITH HEPATIC UNSPECIFIED VIRAL HEPATITIS WITHOUT HEPATIC OTHER PARAPROTEINEMIAS DISORDERS OF IRON METABOLISM DISORDERS OF COPPER METABOLISM DISORDERS OF PORPHYRIN METABOLISM AMYLOIDOSIS, UNSPECIFIED FAMILIAL MEDITERRANEAN FEVER OTHER AMYLOIDOSIS MONONEURITIS MULTIPLEX * CORNEAL ULCER UNSPECIFIED POLYARTERITIS NODOSA 452 PORTAL VEIN THROMBOSIS BUDD-CHIARI SYNDROME ESOPHAGEAL VARICES WITH BLEEDING ESOPHAGEAL VARICES WITHOUT BLEEDING ESOPHAGEAL VARICES IN DISEASES CLASSIFIED ELSEWHERE WITH BLEEDING

3 ESOPHAGEAL VARICES IN DISEASES CLASSIFIED ELSEWHERE WITHOUT BLEEDING IDIOPATHIC FIBROSING ALVEOLITIS 570 ACUTE AND SUBACUTE NECROSIS OF LIVER ALCOHOLIC FATTY LIVER ACUTE ALCOHOLIC HEPATITIS ALCOHOLIC CIRRHOSIS OF LIVER ALCOHOLIC LIVER DAMAGE UNSPECIFIED CHRONIC HEPATITIS UNSPECIFIED CHRONIC PERSISTENT HEPATITIS AUTOIMMUNE HEPATITIS OTHER CHRONIC HEPATITIS CIRRHOSIS OF LIVER WITHOUT ALCOHOL BILIARY CIRRHOSIS OTHER CHRONIC NONALCOHOLIC LIVER DISEASE UNSPECIFIED CHRONIC LIVER DISEASE WITHOUT ALCOHOL ABSCESS OF LIVER PORTAL PYEMIA HEPATIC ENCEPHALOPATHY PORTAL HYPERTENSION HEPATORENAL SYNDROME OTHER SEQUELAE OF CHRONIC LIVER DISEASE HEPATITIS IN VIRAL DISEASES CLASSIFIED ELSEWHERE HEPATITIS IN OTHER INFECTIOUS DISEASES CLASSIFIED ELSEWHERE HEPATITIS UNSPECIFIED OTHER SPECIFIED DISORDERS OF LIVER UNSPECIFIED DISORDER OF LIVER NEPHRITIS AND NEPHROPATHY NOT SPECIFIED AS ACUTE OR CHRONIC WITH LESION OF MEMBRANOUS GLOMERULONEPHRITIS ACUTE KIDNEY FAILURE, UNSPECIFIED CHRONIC KIDNEY DISEASE, STAGE III (MODERATE) CHRONIC KIDNEY DISEASE, STAGE IV (SEVERE) CHRONIC KIDNEY DISEASE, STAGE V END STAGE RENAL DISEASE OTHER SPECIFIED LOCAL INFECTIONS OF SKIN AND SUBCUTANEOUS TISSUE LICHEN PLANUS FEBRILE CONVULSIONS (SIMPLE), UNSPECIFIED COMPLEX FEBRILE CONVULSIONS

4 CHRONIC FATIGUE SYNDROME OTHER MALAISE AND FATIGUE JAUNDICE UNSPECIFIED NOT OF NEWBORN ANOREXIA ABNORMAL WEIGHT GAIN LOSS OF WEIGHT UNDERWEIGHT FEEDING DIFFICULTIES AND MISMANAGEMENT UNSPECIFIED LACK OF NORMAL PHYSIOLOGICAL DEVELOPMENT FAILURE TO THRIVE DELAYED MILESTONES SHORT STATURE POLYDIPSIA POLYPHAGIA OTHER SYMBOLIC DYSFUNCTION NAUSEA WITH VOMITING NAUSEA ALONE VOMITING ALONE ABDOMINAL PAIN UNSPECIFIED SITE ABDOMINAL PAIN RIGHT UPPER QUADRANT ABDOMINAL PAIN LEFT UPPER QUADRANT ABDOMINAL PAIN RIGHT LOWER QUADRANT ABDOMINAL PAIN LEFT LOWER QUADRANT ABDOMINAL PAIN PERIUMBILIC ABDOMINAL PAIN EPIGASTRIC ABDOMINAL PAIN GENERALIZED ABDOMINAL PAIN OTHER SPECIFIED SITE NONSPECIFIC ELEVATION OF LEVELS OF TRANSAMINASE OR LACTIC ACID DEHYDROGENASE (LDH) NONSPECIFIC ABNORMAL RESULTS OF FUNCTION STUDY OF LIVER COMPLICATIONS OF TRANSPLANTED LIVER OTHER SERUM REACTION NOT ELSEWHERE CLASSIFIED V01.79 CONTACT OR EXPOSURE TO OTHER VIRAL DISEASES V02.60 CARRIER OR SUSPECTED CARRIER OF VIRAL HEPATITIS UNSPECIFIED V02.61 CARRIER OR SUSPECTED CARRIER OF HEPATITIS B V02.62 CARRIER OR SUSPECTED CARRIER OF HEPATITIS C V02.69 CARRIER OR SUSPECTED CARRIER OF OTHER VIRAL HEPATITIS V10.07 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF LIVER

5 V15.85 PERSONAL HISTORY OF CONTACT WITH AND (SUSPECTED) EXPOSURE TO POTENTIALLY HAZARDOUS BODY FLUIDS V45.11 RENAL DIALYSIS STATUS V56.0 AFTERCARE INVOLVING EXTRACORPOREAL DIALYSIS V56.8 AFTERCARE INVOLVING OTHER DIALYSIS V71.89* OBSERVATION FOR OTHER SPECIFIED SUSPECTED CONDITIONS *Use ICD-9-CM code to report Mooren s corneal ulcer. *Use V71.89 when testing patients with B-cell lymphoma for hepatitis C. The appropriate B-cell lymphoma ICD-9-CM code should also be submitted. *Use V71.89 when viral hepatitis serologies are necessary prior to chemotherapy or other immunosuppressive therapy.

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