January 30, 2012

Coding for Viral Hepatitis
For The Record
Vol. 24 No. 2 P. 27

Viral hepatitis is a group of viral infections that affect the liver. The most common types are hepatitis A, B, and C. It is the leading cause of liver cancer and most common reason for liver transplantation. According to the Centers for Disease Control and Prevention, 4.4 million Americans have chronic hepatitis, and 80,000 new infections occur each year.

Types of Viral Hepatitis
There are five main types of viral hepatitis (A, B, C, D, E), but types F and G are also being researched. As more research is done, it is likely that the alphabetical list will expand. All types of viral hepatitis are classified to ICD-9-CM category 070.

Hepatitis A: It is transmitted orally through food or water contaminated by fecal matter and may spread through the improper handling of food, contact with household members, sharing toys at day care centers, and eating raw shellfish from polluted waters. Hepatitis A is an acute condition that does not lead to chronic inflammation. Severity is usually mild, but it can cause acute fulminant hepatitis resulting in death or requiring a liver transplant. Assign code 070.1 for a hepatitis A diagnosis or 070.0 for hepatitis A with hepatic coma.

Hepatitis B: It is most often transmitted percutaneously via body fluids and exposure to blood products. It is spread through sexual contact, blood transfusion, or exposure to an infected person’s blood through cuts, open sores, needle sticks, razor sharing, tattooing, and ear/body piercing tools. It may also be spread from mother to infant at birth. Severity is often severe with a moderate level of progressive chronicity and may cause cirrhosis, liver failure, or liver cancer. Hepatitis B is classified to the following codes:

• 070.20, Acute or unspecified hepatitis B with hepatic coma;

• 070.22, Chronic hepatitis B with hepatic coma;

• 070.30, Acute or unspecified hepatitis B without hepatic coma; or

• 070.32, Chronic hepatitis B without hepatic coma.

Hepatitis C: It is transmitted primarily by needles shared among drug abusers, blood transfusion, hemodialysis, and needle sticks. It is rarely transmitted by sexual contact. It is considered moderately severe with the potential to become chronic and therefore may result in cirrhosis, liver cancer, or liver failure. Hepatitis C is classified to the following codes:

• 070.41, Acute hepatitis C with hepatic coma;

• 070.44, Chronic hepatitis C with hepatic coma;

• 070.51, Acute hepatitis C without hepatic coma;

• 070.54, Chronic hepatitis C without hepatic coma;

• 070.70, Unspecified viral hepatitis C without hepatic coma; or

• 070.71, Unspecified viral hepatitis C with hepatic coma.

Code 070.54 may be assigned for the documentation of hepatitis C described as in remission (AHA Coding Clinic for ICD-9-CM, 2006, second quarter, page 13).

Hepatitis D: Better known as hepatitis delta, it can only occur in people infected with hepatitis B; it cannot survive on its own. It is transmitted through needle sharing, sexual contact, and from mother to infant at birth. It can cause both acute and chronic disease. The following codes identify hepatitis D:

• 070.21, Acute or unspecified hepatitis B with hepatic coma with hepatitis delta;

• 070.23, Chronic hepatitis B with hepatic coma with hepatitis delta;

• 070.31, Acute or unspecified hepatitis B without hepatic coma with hepatitis delta;

• 070.33, Chronic hepatitis B without hepatic coma with hepatitis delta;

• 070.42, Hepatitis delta without mention of active hepatitis B disease with hepatic coma; or

• 070.52, Hepatitis delta without mention of active hepatitis B disease or hepatic coma.

Hepatitis E: It resembles hepatitis A and is transmitted through fecal contamination. It is considered an acute condition and does not lead to chronic hepatitis. Hepatitis E is classified to either code 070.43 or 070.53 depending on the presence of hepatic coma.

If other types of viral hepatitis are documented, such as hepatitis G, then assign code 070.49 with hepatic coma or code 070.59 without hepatic coma.

Patients with chronic viral hepatitis may become carriers, which means they can transmit the disease to others even when the symptoms have disappeared. Carriers of viral hepatitis are classified to codes V02.60 to V02.69. The specific code depends on the type of viral hepatitis.

Hepatic Coma
Hepatic encephalopathy/hepatic coma/portal-systemic encephalopathy (572.2) is defined as a deterioration of brain function due to the buildup of toxic substances (such as ammonia) in the brain that are normally removed by the liver. Symptoms include confusion, disorientation, drowsiness, and personality, mood, and behavior changes. Lab tests include elevated ammonia levels. Lactulose is used to treat hepatic encephalopathy and is a laxative, which, if used in higher doses, reduces ammonia absorption from the colon.

Liver conditions frequently associated with hepatic encephalopathy include end-stage liver disease, cirrhosis, hepatic malignancies, and hepatitis. As previously mentioned, hepatic encephalopathy associated with viral hepatitis is integral to the disease process.

If a patient is admitted with viral hepatitis and also has hepatic encephalopathy, do not list hepatic encephalopathy (572.2) as a secondary diagnosis. Hepatic encephalopathy/coma is included in the code for the viral hepatitis (AHA Coding Clinic for ICD-9-CM, 2007, second quarter, page 6.)

Coding and sequencing for viral hepatitis are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.

 

Viral Hepatitis in ICD-10-CM
In ICD-10-CM, viral hepatitis is classified to code range B15 to B19. The categories are as follows:

• B15, Acute hepatitis A

• B16, Acute hepatitis B

• B17, Other acute viral hepatitis (includes acute hepatitis types C, D, E, other, and unspecified)

• B18, Chronic viral hepatitis (includes chronic hepatitis types B, C, D, other, and unspecified); and

• B19, Unspecified viral hepatitis (includes viral hepatitis types that are not specified as acute or chronic).

Hepatic coma is classified in ICD-10-CM as hepatic failure, by type, with coma. The types may include acute/subacute, alcoholic, chronic, due to drugs, or postprocedural and is classified to code range K70 to K72. There is an excludes 2 (which means “not included here”) note under the code block K70 to K77, which excludes viral hepatitis (B15 to B19). Therefore, if the patient has hepatic coma with viral hepatitis, a code from code range B15 to B19 would be assigned instead of a code from K70 to K72.

— AH

 

Summary of Viral Hepatitis

Type	Transmission	Incubation Period	Severity	Can Become Chronic?	ICD-9-CM Code
A	Fecal/oral	15 to 50 days	Mild	No	070.0 or 070.1
B	Blood/body fluids	6 weeks to 6 months	Severe	Yes	070.20, 070.22, 070.30, 070.32
C	Blood	2 weeks to 6 months	Moderate to severe	Yes	070.41, 070.44, 070.51, 070.54, 070.70, 070.71
D	Blood/body fluids	1 to 6 months	Moderate to severe	Yes	070.21, 070.23, 070.31, 070.33, 070.42, 070.52
E	Fecal/oral	3 to 8 weeks	Mild	No	070.43, 070.53