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Coding Guidelines for Hepatitis B Screening - Reimbursement Tips


This would help your organization join the fight against Hepatitis B (HBV) infection by understanding what conditions are necessary for coverage of HBV screening and how to properly code the Hepatitis B surface antigen (HBsAg) serologic test.

Conditions for Coverage of HBsAg Serologic Testing:

The patient’s primary care physician or practitioner,  an eligible Medicare provider, must order the screening within the context of a primary care setting.

The screening must be performed by appropriate U.S. Food and Drug Administration (FDA) approved/cleared laboratory tests, used consistent with FDA approved labeling and in compliance with the Clinical Laboratory Improvement Act (CLIA) regulations.

Patients must be either,
  • Pregnant – A screening test at the first prenatal visit is covered and then re-screening at time of delivery for those with new or continuing risk factors.
    • Screening for each pregnancy, regardless of previous hepatitis B vaccination or previous negative HBsAg test results
  • Asymptomatic, nonpregnant adolescent/adult at high risk for HBV infection.
    • Coverage provides one screening annually.
Procedure Coding for HBV Screening:

86704 - Hepatitis B core antibody (HBcAb); total

86706 - Hepatitis B surface antibody (HBsAb)

87340 - Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg)

87341 - Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg) neutralization

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)

Diagnosis Coding for HBV Screening:

For HBV screening in pregnant women (CPT codes 86704, 86706, 87340 and 87341) report Z11.59 Encounter for screening for other viral diseases with one of the following diagnosis codes,

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

For HBV screening in pregnant women at high risk, report the appropriate CPT code with Z11.59, Z72.89 Other problems related to lifestyle and one of the following ICD-10-CM codes, as appropriate,

Z34.00 – Z34.03 – Encounter for supervision of normal first pregnancy
Z34.80 – Z34.83 – Encounter for supervision of other normal pregnancy
Z34.90 – Z34.93 – Encounter for supervision of normal pregnancy, unspecified
O09.90 – O09.93 – Supervision of high risk pregnancy, unspecified

For non-pregnant adolescents/adults at high risk for HBV infection, CMS will allow coverage for G0499 only when services are reported with 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

Additional Information:

For claims with dates of service on or after September 28, 2016, CMS will allow coverage for HBV screening only when submitted with one of the following Place of Service (POS) codes,
  • 11 - Physician’s Office
  • 19 - Off Campus Outpatient Hospital
  • 22 - On Campus Outpatient Hospital
  • 49 - Independent Clinic
  • 71 - State or Local Public Health Clinic
  • 81 - Independent Laboratory
Claims submitted without one of the POS codes noted above will be denied. 

For claims with dates of service on or after September 28, 2016, CMS will allow coverage for HBV screening only when services are submitted by the following provider specialties found on the provider’s enrollment record,
  • 01 - General Practice
  • 08 - Family Practice
  • 11 - Internal Medicine
  • 16 - Obstetrics/Gynecology
  • 37 - Pediatric Medicine
  • 38 - Geriatric Medicine
  • 42 - Certified Nurse Midwife
  • 50 - Nurse Practitioner
  • 89 - Certified Clinical Nurse Specialist
  • 97 - Physician Assistant
Claims submitted by providers other than the specialty types noted above will be denied. 

Source: https://www.aapc.com/blog/48106-coding-hepatitis-b-screening/

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