How To Use CPT Code 81596

CPT 81596 describes the performance of six biochemical assays and the use of a prognostic algorithm to assess liver fibrosis and necroinflammatory activity in patients with chronic hepatitis C virus (HCV) infection. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 81596?

CPT 81596 is used to describe the performance of six biochemical assays and the subsequent analysis using a prognostic algorithm to determine the severity of liver fibrosis and necroinflammatory activity in patients with chronic HCV infection. This code is used when a lab analyst conducts the necessary tests and utilizes patient data to generate a prognostic score for liver fibrosis and necroinflammation.

2. Official Description

The official description of CPT code 81596 is: ‘Infectious disease, chronic hepatitis C virus (HCV) infection, six biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, and haptoglobin) utilizing serum, prognostic algorithm reported as scores for fibrosis and necroinflammatory activity in liver.’

3. Procedure

1. The lab analyst performs six biochemical assays, including ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, and haptoglobin, using serum samples.
2. The lab analyst inputs the test results into a computer program that utilizes a prognostic algorithm.
3. The algorithm analyzes the data, including patient-specific information, to generate scores for liver fibrosis and necroinflammatory activity.
4. The lab analyst reports the prognostic scores for fibrosis and necroinflammatory activity in the liver.

4. Qualifying circumstances

CPT 81596 is used for patients with chronic HCV infection who require an assessment of liver fibrosis and necroinflammatory activity. The test is ordered by clinicians to evaluate liver status at critical times, such as following diagnosis or treatment. The test helps predict the likelihood of liver fibrosis and necroinflammation in these patients.

5. When to use CPT code 81596

CPT code 81596 should be used when a lab analyst performs the six biochemical assays and utilizes a prognostic algorithm to assess liver fibrosis and necroinflammatory activity in patients with chronic HCV infection. This code should be reported when the test is performed and the prognostic scores are reported.

6. Documentation requirements

To support a claim for CPT 81596, the following documentation is required:

• Indication of chronic HCV infection
• Results of the six biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, and haptoglobin)
• Prognostic scores for liver fibrosis and necroinflammatory activity
• Signature of the lab analyst performing the tests and generating the scores

7. Billing guidelines

When billing for CPT 81596, ensure that the test is performed for patients with chronic HCV infection and that the six biochemical assays are conducted. Do not separately report the individual lab tests included in CPT 81596. There are no specific guidelines regarding reporting CPT 81596 with other codes.

8. Historical information

CPT 81596 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performs the six biochemical assays and utilizes a prognostic algorithm to generate scores for liver fibrosis and necroinflammatory activity in a patient with chronic HCV infection.
2. Following the diagnosis of chronic HCV infection, a lab analyst conducts the necessary tests and reports the prognostic scores for liver fibrosis and necroinflammatory activity.
3. As part of the treatment monitoring process, a lab analyst performs the six biochemical assays and utilizes a prognostic algorithm to assess the severity of liver fibrosis and necroinflammatory activity in a patient with chronic HCV infection.
4. Upon completion of HCV treatment, a lab analyst performs the necessary tests and generates prognostic scores for liver fibrosis and necroinflammatory activity to evaluate the effectiveness of the treatment.
5. A lab analyst conducts the six biochemical assays and utilizes a prognostic algorithm to assess the progression of liver fibrosis and necroinflammatory activity in a patient with chronic HCV infection over time.