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Pathology/Lab Coding Alert

Reader Question:

Hepatitis Doesn't Guarantee Panel Pay

Question: A physician ordered a hepatitis panel with diagnosis code 070.51, but Medicare denied payment. What could be the problem? Kansas Subscriber Answer: Although 070.51 (Acute hepatitis C without mention of hepatic coma) is on the “ICD-9 codes covered by Medicare” list in the laboratory National Coverage Determination (NCD) for hepatitis panel, many factors could lead to a denial. Based on symptoms such as fatigue, weight loss, and jaundice, the physician may order a hepatitis panel (80074, Acute hepatitis panel), which includes individual tests for hepatitis B surface antigen (87340), hepatitis C antibody (86803), hepatitis B core antibody (HBcAb), IgM antibody (86705), hepatitis A antibody (HAAb), and IgM antibody (86709). Know panel medical necessity: CMS gives three indications of when your physician may provide a hepatitis panel: To detect viral hepatitis infection when there are abnormal liver function test results, with or without signs or symptoms of hepatitis Prior to [...]