When coding Chronic Hepatitis C, there has to be proper provider documentation to confirm an active, chronic infection, and then Chronic Hepatitis C can be supported by the ICD-10-CM code B18.2. Coders are also required to document and code complications such as cirrhosis and/or hepatic failure and/or hepatocellular carcinoma, along with appropriate coding and sequencing. A thorough understanding of a payer’s medical necessity, prior authorization, and antiviral therapy coverage fosters decreased denials, encourages compliance, and ensures appropriate reimbursement in a timely manner.
Chronic Hepatitis C (HCV) is a long-standing viral infection that mainly affects the liver and progressively leads to severe complications such as liver fibrosis, cirrhosis, hepatic failure, and liver cancer (hepatocellular carcinoma). Due to the chronic nature and the expense associated with treatment of the disease, the importance of coding ICD-10-CM is directly linked to effective clinical communication, reimbursement, and compliance with regulations. Appropriate coding communicates to payers the seriousness of the medical condition, the necessity of continued surveillance, and the rationale for the provision of antiviral treatment. Chronic Hepatitis C and associated complications can only be correctly described, if the coding professional is provided with specific and detailed documentation by the provider and has a sound grasp of the ICD-10 guidelines.
Chronic Hepatitis C
Hepatitis C is defined as the infection with the Hepatitis C virus that lasts longer than six months. Symptoms may not present for long durations of time or may present as fatigue, belly pain and/or signs of advanced liver disease. To understand and document the various stages of Hepatitis C infection – acute, chronic, or resolved – different codes need to be assigned. In the absence of clear medical documentation indicating that a case is chronic, coders are unable to assume chronicity, even if an infection has been present for an extended period of time.The medical documentation will support the codes assigned and aid in keeping the practice compliant.
Chronic Hepatitis C Category in the ICD-10-CM System
Chronic Hepatitis C is categorized in the ICD-10-CM system as B-18 which is the designation for chronic viral Hepatitis. The precise diagnostic code for this condition is B18.2 which corresponds to chronic viral Hepatitis C. The chronic Hepatitis C infection is described by this code regardless of the viral genotype.
In the ICD-10-CM coding system, separate codes do not have to be assigned for each of the different genotypes of Hepatitis C, therefore, for diagnosis coding, this information will not be used. Right application of the B18.2 code will demonstrate that the patient has an infection that is active as well as chronic and it is important that the patient continues to receive follow up medical care.
Coding Chronic Hepatitis C and Hepatic Encephalopathy
Compared to other codes for chronic hepatitis, B18.2 has no specific mention for hepatic coma and encephalopathy. When a patient has chronic Hepatitis C and then develops hepatic failure or encephalopathy, these other diagnoses must be added. For instance, K72.90 would be reported for hepatic failure, or K72.91 for hepatic failure with coma. These additional codes point out important clinical specifics and justify resource utilization in advanced level monitoring, admission, or need for specialty care. Assigning B18.2 and not reporting these complications is underreporting the severity of the disease.
Coding Chronic Hepatitis C With Cirrhosis
A cirrhosis of the liver is a common, long-term complication of chronic Hepatitis C, and must be coded, in addition to B18.2 when present. For documentation purposes, cirrhosis is located in code category K74. If documentation states that cirrhosis actually is secondary to Hepatitis C, then both conditions are warranted for reporting to be comprehensive. Due to the subclass of the liver disease (cichotic) that is instigated by the hepatitis C virus, the primary reason for the health care encounter is typically chronic Hepatitis C when it focuses on antiviral therapy or the monitoring of disease progression, with cirrhosis being the secondary diagnosis.
Coding for Hepatocellular Carcinoma with Chronic Hepatitis C
Chronic Hepatitis C has skyrocketed in patients because of the increased risk of developing hepatocellular carcinoma. In this case, coders need to document both the C22.0 for liver cell carcinoma and B18.2 for chronic Hepatitis C. The sequencing is determined based on the visit purpose. If the visit is for treating the cancer, the malignancy code goes first. If the primary reason for the visit is to manage the viral infection, B18.2 can be the primary diagnosis. Proper sequencing does align claims with the purpose of the visit and the medical services provided.
Chronic Hepatitis C Documentation
Payers need the documentation to show that Hepatitis C is chronic and is current. The provider notes must show the diagnosis, the infection duration, and whether the infection is currently monitored, treated, or nothing has been done. The notes also need to explain any issues such as cirrhosis, ascites, or hepatic failure, and whether these are related to Hepatitis C. Diagnostic lab tests and imaging are good to have, but the provider’s assessment should drive the coding. Documentation that is vague or partial increases the chances of claim denials.
Active Chronic Infection VS Past Cases of Hepatitis C
Active chronic infections should be differentiated from past cases of Hepatitis C. For example, if the patient has been treated successfully and has no traces of the virus, then the history code, Z86.19, should be applied instead of B18.2. Applying B18.2 incorrectly depicts the patient’s state and could create unfavorable reimbursement or audit situations. The absence of the terms “resolved,” “cured,” or “sustained virologic response” should be documented and restrict the application of a chronic infection code.
Chronic Hepatitis C Sequencing Guidelines
Sequencing is based on the objectives of the encounter and the services rendered. If a visit is focused on the initiation of antiviral therapy, evaluation of viral load, and/or routine monitoring for chronic Hepatitis C, B18.2 is most often the primary diagnosis. In cases where the patient is treated for a complication first, e.g. hepatic encephalopathy, ascites, or liver malignancy, that complication may be sequenced first, with B18.2 relegated to secondary diagnosis status. This effectively maintains alignment of the claim with the main objectives of the clinical scenario and the expectations of the payer.
Payer Medical Necessity Expectations
Thorough explanation, along with proof of medical necessity, is often a requirement of payers when processing services related to chronic Hepatitis C. Such proof typically includes confirmation of an active infection, an evaluation of liver involvement, and documentation justifying the selected approach to treatment. For claims with B18.2 pending the clinical context, the most costly ones will likely be denied. Therefore, capturing all pertinent diagnoses is critical in justifying the service requests.
Payer Policies for Antiviral Therapy Coverage
Policies for the coverage of direct-acting antiviral medications are very payer specific and may, for example, request evidence of fibrosis stage, the presence of cirrhosis, or a specialist consultation. In cases where these conditions are documented, the inclusion of secondary diagnosis codes describing their severity supports the claim, especially with respect to prior authorization. The absence of these factors may ignore the conditions and delay or deny approval.
Prior Authorization Considerations
Treatment of chronic Hepatitis C commonly requires prior authorization. Diagnosis codes related to the progression of the disease or related complications may be requested by payers. Such diagnosis codes streamline the approval process, and thorough and accurate coding minimizes the workload for the staff and reduces the time to a decision.
Most Frequent Coding Mistakes
Mistakes include not using the specified hepatitis codes, history and active infection code mix-ups, failure to include related liver problems, and improper code order. Denials, delayed payments, and audit issues may arise from these errors. Ongoing training and quality review are important to mitigate these problems.
Compliance and Audit Risks
A great deal of scrutiny is placed on claims due to the high costs associated with the treatment of Hepatitis C. Because of this, it is critical for the coder to have the correct documentation justifying the diagnosis, the level of complexity, and the treatment. Following ICD-10 guidelines along with the respective payer’s rules helps to mitigate risk of compliance with regards to healthcare revenue protection.
Collaboration Between Providers and Coders
The collaboration between the provider and the coding staff has a positive effect on the quality of the documentation, improving the coding on the claims. It is the responsibility of the provider to indicate the chronic nature and the associated conditions, whereas the coder has the responsibility to follow up with documentation that is insufficient. This is especially true for more complex claims where the payer’s demands are more stringent in order to receive a timely payment.
Conclusion
The ability to code chronic Hepatitis C in the ICD-10-CM system requires that the documentation be correct, that the codes selected be based on the payor’s demands and that the codes that are used must reflect the chronic nature of HCV B18.2, which is the principal code that is used to code chronic HCV, along with the other codes that reflect HCV associated problems and the level of HCV symptoms. When healthcare institutions minimize the potential revenue losses by doing the necessary coding and documenting, they support the medical necessity for the treatment and care of chronic Hepatitis C as well as the revenue cycle by lowering the denial rates.
Make An Appintment With A2ZFAQs
There is only one specific ICD-10 code for chronic Hepatitis C, which is B18.2. This code is applicable only to patients who are documented to have an active, long-term infection with Hepatitis C.
No. For patients who have resolved the infection, B18.2 cannot be reported. As an alternative, a history code is applicable, like Z86.19.
Yes. When documented, cirrhosis, hepatic failure, or liver cancer must be coded in addition to B18.2.
This may vary depending on the reason for the encounter. For management of HCV, B18.2 is usually primary. However, if complications are the focus of care, those may be primary.
Documenting the active infection, the severity of the disease, and the medical necessity for antiviral therapy are all critical to the approval of these services and to the provision of the necessary services.