LCD for Viral Hepatitis Serology Tests Applicable CPT Code(s): 86692 Antibody; Hepatitis, Delta Agent 86704 Hepatitis B Core Antibody (HBcAb); Total 86705 Hepatitis B Core Antibody (HBcAb); IgM Antibody 86706 Hepatitis B Surface Antibody (HBsAb) 86707 Hepatitis Be Antibody (HBeAb) 86708 Hepatitis A Antibody (HAAb); Total 86709 Hepatitis A Antibody (HAAb); IgM Antibody 86803 Hepatitis C Antibody; 86804 Hepatitis C Antibody; Confirmatory Test (EG, Immunoblot) 87340 Infectious Agent Antigen Detection by Enzyme Immunoassay Hepatitis B Surface Antigen (HBsAg) 87341 Infectious Agent Antigen Detection by Enzyme Immunoassay Hepatitis B Surface Antigen (HBsAg) neutralization 87350 Infectious Agent Antigen Detection by Enzyme Immunoassay Hepatitis Be Antigen (HBeAg) 87380 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 070.0 VIRAL HEPATITIS A WITH HEPATIC 070.1 VIRAL HEPATITIS A WITHOUT HEPATIC 070.20 VIRAL HEPATITIS B WITH HEPATIC ACUTE OR UNSPECIFIED WITHOUT HEPATITIS DELTA 070.21 VIRAL HEPATITIS B WITH HEPATIC ACUTE OR UNSPECIFIED WITH HEPATITIS DELTA 070.22 CHRONIC VIRAL HEPATITIS B WITH HEPATIC WITHOUT HEPATITIS DELTA 070.23 CHRONIC VIRAL HEPATITIS B WITH HEPATIC WITH HEPATITIS DELTA 070.30 VIRAL HEPATITIS B WITHOUT HEPATIC ACUTE OR UNSPECIFIED WITHOUT HEPATITIS DELTA
070.31 VIRAL HEPATITIS B WITHOUT HEPATIC ACUTE OR UNSPECIFIED WITH HEPATITIS DELTA 070.32 CHRONIC VIRAL HEPATITIS B WITHOUT HEPATIC WITHOUT HEPATITIS DELTA 070.33 CHRONIC VIRAL HEPATITIS B WITHOUT HEPATIC WITH HEPATITIS DELTA 070.41 ACUTE HEPATITIS C WITH HEPATIC 070.42 HEPATITIS DELTA WITHOUT ACTIVE HEPATITIS B DISEASE WITH HEPATIC HEPATITIS DELTA WITH HEPATITIS B CARRIER STATE 070.43 HEPATITIS E WITH HEPATIC 070.44 CHRONIC HEPATITIS C WITH HEPATIC 070.49 OTHER SPECIFIED VIRAL HEPATITIS WITH HEPATIC 070.51 ACUTE HEPATITIS C WITHOUT MENTION OF HEPATIC 070.52 HEPATITIS DELTA WITHOUT ACTIVE HEPATITIS B DISEASE OR HEPATIC 070.53 HEPATITIS E WITHOUT HEPATIC 070.54 CHRONIC HEPATITIS C WITHOUT HEPATIC 070.59 OTHER SPECIFIED VIRAL HEPATITIS WITHOUT HEPATIC 070.6 UNSPECIFIED VIRAL HEPATITIS WITH HEPATIC 070.70 UNSPECIFIED VIRAL HEPATITIS C WITHOUT HEPATIC 070.71 UNSPECIFIED VIRAL HEPATITIS C WITH HEPATIC 070.9 UNSPECIFIED VIRAL HEPATITIS WITHOUT HEPATIC 273.2 OTHER PARAPROTEINEMIAS 275.0 DISORDERS OF IRON METABOLISM 275.1 DISORDERS OF COPPER METABOLISM 277.1 DISORDERS OF PORPHYRIN METABOLISM 277.30 AMYLOIDOSIS, UNSPECIFIED 277.31 FAMILIAL MEDITERRANEAN FEVER 277.39 OTHER AMYLOIDOSIS 354.5 MONONEURITIS MULTIPLEX 370.00* CORNEAL ULCER UNSPECIFIED 446.0 POLYARTERITIS NODOSA 452 PORTAL VEIN THROMBOSIS 453.0 BUDD-CHIARI SYNDROME 456.0 ESOPHAGEAL VARICES WITH BLEEDING 456.1 ESOPHAGEAL VARICES WITHOUT BLEEDING 456.20 ESOPHAGEAL VARICES IN DISEASES CLASSIFIED ELSEWHERE WITH BLEEDING
456.21 ESOPHAGEAL VARICES IN DISEASES CLASSIFIED ELSEWHERE WITHOUT BLEEDING 516.3 IDIOPATHIC FIBROSING ALVEOLITIS 570 ACUTE AND SUBACUTE NECROSIS OF LIVER 571.0 ALCOHOLIC FATTY LIVER 571.1 ACUTE ALCOHOLIC HEPATITIS 571.2 ALCOHOLIC CIRRHOSIS OF LIVER 571.3 ALCOHOLIC LIVER DAMAGE UNSPECIFIED 571.40 CHRONIC HEPATITIS UNSPECIFIED 571.41 CHRONIC PERSISTENT HEPATITIS 571.42 AUTOIMMUNE HEPATITIS 571.49 OTHER CHRONIC HEPATITIS 571.5 CIRRHOSIS OF LIVER WITHOUT ALCOHOL 571.6 BILIARY CIRRHOSIS 571.8 OTHER CHRONIC NONALCOHOLIC LIVER DISEASE 571.9 UNSPECIFIED CHRONIC LIVER DISEASE WITHOUT ALCOHOL 572.0 ABSCESS OF LIVER 572.1 PORTAL PYEMIA 572.2 HEPATIC ENCEPHALOPATHY 572.3 PORTAL HYPERTENSION 572.4 HEPATORENAL SYNDROME 572.8 OTHER SEQUELAE OF CHRONIC LIVER DISEASE 573.1 HEPATITIS IN VIRAL DISEASES CLASSIFIED ELSEWHERE 573.2 HEPATITIS IN OTHER INFECTIOUS DISEASES CLASSIFIED ELSEWHERE 573.3 HEPATITIS UNSPECIFIED 573.8 OTHER SPECIFIED DISORDERS OF LIVER 573.9 UNSPECIFIED DISORDER OF LIVER 583.1 NEPHRITIS AND NEPHROPATHY NOT SPECIFIED AS ACUTE OR CHRONIC WITH LESION OF MEMBRANOUS GLOMERULONEPHRITIS 584.9 ACUTE KIDNEY FAILURE, UNSPECIFIED 585.3 CHRONIC KIDNEY DISEASE, STAGE III (MODERATE) 585.4 CHRONIC KIDNEY DISEASE, STAGE IV (SEVERE) 585.5 CHRONIC KIDNEY DISEASE, STAGE V 585.6 END STAGE RENAL DISEASE 686.8 OTHER SPECIFIED LOCAL INFECTIONS OF SKIN AND SUBCUTANEOUS TISSUE 697.0 LICHEN PLANUS 780.31 FEBRILE CONVULSIONS (SIMPLE), UNSPECIFIED 780.32 COMPLEX FEBRILE CONVULSIONS
780.71 CHRONIC FATIGUE SYNDROME 780.79 OTHER MALAISE AND FATIGUE 782.4 JAUNDICE UNSPECIFIED NOT OF NEWBORN 783.0 ANOREXIA 783.1 ABNORMAL WEIGHT GAIN 783.21 LOSS OF WEIGHT 783.22 UNDERWEIGHT 783.3 FEEDING DIFFICULTIES AND MISMANAGEMENT 783.40 UNSPECIFIED LACK OF NORMAL PHYSIOLOGICAL DEVELOPMENT 783.41 FAILURE TO THRIVE 783.42 DELAYED MILESTONES 783.43 SHORT STATURE 783.5 POLYDIPSIA 783.6 POLYPHAGIA 784.69 OTHER SYMBOLIC DYSFUNCTION 787.01 NAUSEA WITH VOMITING 787.02 NAUSEA ALONE 787.03 VOMITING ALONE 789.00 ABDOMINAL PAIN UNSPECIFIED SITE 789.01 ABDOMINAL PAIN RIGHT UPPER QUADRANT 789.02 ABDOMINAL PAIN LEFT UPPER QUADRANT 789.03 ABDOMINAL PAIN RIGHT LOWER QUADRANT 789.04 ABDOMINAL PAIN LEFT LOWER QUADRANT 789.05 ABDOMINAL PAIN PERIUMBILIC 789.06 ABDOMINAL PAIN EPIGASTRIC 789.07 ABDOMINAL PAIN GENERALIZED 789.09 ABDOMINAL PAIN OTHER SPECIFIED SITE 790.4 NONSPECIFIC ELEVATION OF LEVELS OF TRANSAMINASE OR LACTIC ACID DEHYDROGENASE (LDH) 794.8 NONSPECIFIC ABNORMAL RESULTS OF FUNCTION STUDY OF LIVER 996.82 COMPLICATIONS OF TRANSPLANTED LIVER 999.5 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
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 370.00 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.