Coding for Hepatitis C

ACOG, the Centers for Disease Control and Prevention, and the US Preventive Services Task Force recommend that all pregnant patients should be tested for hepatitis C (Hep C) during each pregnancy.

Hep C testing during pregnancy should be an avenue to encourage a conversation between the pregnant patient and healthcare provider about Hep C transmission and risk factors to them and the fetus. For accurate laboratory test ordering and medical documentation, please see the coding guidance below.

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Encounter Codes (ICD-10-CM) for Ordering Tests

• Z11.59 – Encounter for screening for other infectious and parasitic diseases
• Z22.8 – Carrier of other infectious disease
• Z33.1 – Pregnant state, incidental
• Z33.3 – Pregnant state, gestational carrier
• Z86.19 – Personal history of other infectious and parasitic diseases
• Z72.89 – Other problems related to lifestyle (to be used with HCPCS code G0472) *

Procedural Codes for Ordering or Billing for Hepatitis C Tests

• 86803 – Hepatitis C antibody
• 86804 – Hepatitis C antibody; confirmatory test (e.g., immunoblot)
• 87520 – Infectious agent detection by nucleic acid (DNA or RNA); hepatitis c, direct probe technique
• 87521 – Infectious agent detection by nucleic acid (DNA or RNA); hepatitis c, amplified probe technique, includes reverse transcription when performed
• 87522 – Infectious agent detection by nucleic acid (DNA or RNA); hepatitis c, quantification, includes reverse transcription when performed
• 87902 – Infectious agent genotype by nucleic acid (DNA or RNA); Hepatitis c virus
• G0472 – Hepatitis C antibody screening at high risk and other covered indication(s)
  • Single screening test is covered for adults who do not meet the high-risk criteria
  • Repeat screening is covered annually for high-risk persons who have had continued illicit injection drug use since the prior negative screening test. *

Always check with your laboratory to determine the appropriate code and process for ordering a Hepatitis C test for pregnant patients. Some laboratories may have a bundled code that includes all of the initial tests typically performed for pregnancy.

Diagnosis Code (ICD-10-CM) for reporting Hepatitis C

• O98.41 – Viral hepatitis complicating pregnancy
  • O98.411 – Viral hepatitis complicating pregnancy, first trimester
  • O98.412 – Viral hepatitis complicating pregnancy, second trimester
  • O98.413 – Viral hepatitis complicating pregnancy, third trimester
  • O98.419 – Viral hepatitis complicating pregnancy, unspecified trimester
• O98.42 – Viral hepatitis complicating childbirth
• O98.43 – Viral hepatitis complicating the puerperium

Use additional code (condition in B17 -B19) to identify specific infectious or parasitic disease

• B17.1 – Acute Hepatitis C
• B18.2 – Chronic Viral Hepatitis C
• B19.2 – Unspecified Viral Hepatitis C

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* The HCPCS code G0472 is a Medicare-covered code and for any other payers that follows Medicare guidelines.

Hepatitis C Coverage (Medicare Beneficiaries)

• A screening test is covered for adults at high risk for HCV infection. A person with a current or history of illicit injection drug use, and persons who have a history of receiving blood transfusion prior to 1992 is considered as “High Risk”.
• A repeat screening for high-risk persons is covered annually only for persons who have had continued illicit injection drug use since their prior negative screening test.
• A single screening test is covered for adults who do not meet the high-risk definition above but were born from 1945 – 1965.

The determination of a person considered as “high-risk for HCV” is defined by the primary care physician or practitioner who evaluates the patient’s medical history, either through the preventive or regular visit.

Always check with the payer to determine coverage for Hep C testing in pregnancy. If the payer is not covering this test, please let us know through our Payment Advocacy and Policy Portal.

Evaluation and Management (E/M) Level for Coding and Billing for Hepatitis C – Office/Preventive Visits

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CPT Codes (Minutes) Descriptions

• 99202 (15 – 29)
• 99203 (30 – 44)
• 99204 (45 – 59)
• 99205 (60 – 74)

Office or other outpatient visit for the E/M of a new patient which requires a medically appropriate history and/or examination.

• 99211
• 99212 (10-19)
• 99213 (20-29)
• 99214 (30-39)
• 99215 (40-54)

Office or other outpatient visit for the E/M of an established patient which requires a medically appropriate history and/or examination.

• 99401 (15)
• 99402 (30)
• 99403 (45)
• 99404 (60)

Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure)

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