2017 Billing and Coding Updates on Hepatitis B Screening

1. 2017 Billing and Coding Updates on Hepatitis B Screening www.outsourcestrategies.com 1-800-670-2809

2. Chronic hepatitis B virus (HBV) infection is the leading cause of liver-related morbidity and mortality. Hepatitis screening allows physicians to confirm a diagnosis before symptoms develop and offer a safe and effective therapy. Medical billing and coding services for hepatitis screening must be based on the guidelines provided by Medicare or other concerned insurance companies. Based on the updated recommendations for hepatitis B virus (HBV) screening from U.S. Preventive Services Task Force, Medicare has added Part A and Part B coverage for HBV screening, effective September 28, 2016. www.outsourcestrategies.com 1-800-670-2809

3. Conditions for Medicare Coverage • Medicare will cover screening for HBV infection, only if – • The screening is performed using the appropriate FDA-approved laboratory test, used consistent with FDA-approved labeling and in compliance with the Clinical Laboratory Improvement Act regulations. • The screening is ordered by the patient’s primary care physician or practitioner in the primary care setting. • The patient is either an asymptomatic, non-pregnant adolescent/adult at high risk for HBV infection, or pregnant. • Non-pregnant adolescents/adults at high risk for HBV infection can receive one screening annually. • Pregnant women should be screened at the first prenatal visit (of each pregnancy) and then rescreened at the time of delivery for those with new or continuing risk factors. www.outsourcestrategies.com 1-800-670-2809

4. Medical Codes for HBV Screening • HCPCS • G0499 – Hepatitis B screening in non-pregnant, high risk individual includes hepatitis B surface antigen (HBsAg) followed by a neutralizing confirmatory test for initially reactive results, and antibodies to HBsAg (anti-hbs) and hepatitis B core antigen (anti-hbc) www.outsourcestrategies.com 1-800-670-2809

5. CPT • 86704 – Hepatitis B core antibody (HBcAb); total • 87340 - Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semi-quantitative, multiple step method; hepatitis B surface antigen (HBsAg) • 87341 - Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semi-quantitative, multiple step method; hepatitis B surface antigen (HBsAg) neutralization www.outsourcestrategies.com 1-800-670-2809

6. ICD-10 • CMS will allow coverage for G0499 for HBV screening only when services are reported with both of the following diagnosis codes denoting high risk: • Z11.59 – Encounter for screening for other viral disease • Z72.89 – Other problems related to lifestyle CMS will allow coverage for G0499 for subsequent visits when reported with Z11.59 and one of the following high-risk codes, as appropriate: • F11.10 – F11.99 • F13.10 – F13.99 • F14.10 – F14.99 • F15.10 – F15.99 • Z20.2 • Z20.5 • Z72.52 • Z72.53 www.outsourcestrategies.com 1-800-670-2809

7. For HBV screening in pregnant women, use the right CPT code with Z11.59 and one of the following: • Z34.00 Encounter for supervision of normal first pregnancy, unspecified trimester • Z34.80 Encounter for supervision of other normal pregnancy, unspecified trimester • Z34.90 Encounter for supervision of normal pregnancy, unspecified, unspecified trimester • O09.90 Supervision of high risk pregnancy, unspecified, unspecified trimester www.outsourcestrategies.com 1-800-670-2809

8. For HBV screening in pregnant women at high risk, the appropriate CPT code can be reported with Z11.59, Z72.89, and one of the following ICD-10-CM codes, as appropriate: • Z34.00 – Z34.03 • Z34.80 – Z34.83 • Z34.90 – Z34.93 • O09.90 – O09.93 www.outsourcestrategies.com 1-800-670-2809

9. Physicians can consider outsourcing their complex HBV medical documentation and billing tasks to reliable medical billing companies. Professional companies provide services of AAPC-certified professional coders, who are up-to-date with the current ICD-10 and CPT codes as well as the applicable modifiers based on the factors involved. Thank You! www.outsourcestrategies.com 1-800-670-2809