Recognizing World Hepatitis Day

July 28 is World Hepatitis Day. According to the World Health Organization (WHO), 354 million people live with hepatitis B or C, globally.

What is hepatitis? It is an inflammation of the liver caused by several infectious viruses or non-infectious agents. The five main strains of hepatitis are A, B, C, D, and E:

• Hepatitis A – transmitted through ingestion of contaminated food or water or direct contact with an infectious person.
• Hepatitis B – viral infection, which is most commonly transmitted from mother to child during birth/delivery; contact with blood/fluids during sex with an infected partner; or unsafe injections or exposure to sharp instruments.
• Hepatitis C – bloodborne viral infection contracted through unsafe injections, unscreened blood transfusions, or sex with an infected partner. There is no vaccine for this strain.
• Hepatitis D – requires hepatitis B to replicate and is usually contracted after infection of hepatitis B. Treatment success is low for this strain.
• Hepatitis E – transmitted via fecal-oral route, which is usually by contaminated water. A vaccine is not available in any country other than China.
  

From the coding perspective, viral hepatitis is found in the range of B15-B19. There are options for acute and chronic viral disease. Hepatitis A, B, C, and E can be specifically coded. All ICD-10-CM codes in this range are complication/comorbid conditions (CC), except for the codes that include the descriptor of “hepatic coma.” This condition is also known as hepatic encephalopathy. The brain loses function when the liver can no longer remove toxins from the blood. The codes that contain hepatic coma are major complication/comorbid conditions (MCCs). Other hepatic conditions are bacterial hepatitis (K75.89) and alcoholic hepatitis (K70.10).

In the Medicare Severity Diagnosis Related Groups (MS-DRGs), viral hepatitis as a principal diagnosis will fall in Major Diagnostic Category 7 (Diseases and Disorders of the Hepatobiliary System and Pancreas). More specifically, this is MS-DRGs 441 (with MCC), 442 (w/CC), and 443 (without MCC or CC). Please note that alcoholic hepatitis will be found in MS-DRGs 432 (w/MCC), 433 (w/CC), and 434 (without MCC or CC). These are medical MS-DRGs. If a liver procedure is performed, then the MS-DRGs will change to 405 (w/MCC), 406 (w/CC), and 407 (without MCC or CC). These MS-DRGs are surgical.

The takeaways from this research is that most viral hepatitis is preventable with vaccination, and the documentation of hepatic coma is of vital importance. The incidences of hepatitis A, B, and D are reduced by vaccination. Documentation of hepatic coma identifies an MCC for the case. Clinical documentation specialists and coders should also be aware of the documentation of confusion or altered mental status with patients with viral hepatitis. If hepatic coma is not documented, then a query should be issued.

Remember World Hepatitis Day on July 28!

Programming note: Listen to live coding reports by Laurie Johnson every Tuesday on Talk Ten Tuesdays with Chuck Buck and Dr. Erica Remer.