LCD Reference Article Billing and Coding Article

Billing and Coding: Hepatic (Liver) Function Panel

A57802

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A57802
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Hepatic (Liver) Function Panel
Article Type
Billing and Coding
Original Effective Date
10/03/2018
Revision Effective Date
10/01/2022
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

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CMS National Coverage Policy

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33907 Hepatic (Liver) Function Panel. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier. 

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
  4. If the provider of the service is other than the ordering/referring physician, the provider of the service must maintain hard copy documentation of the test results and interpretation, along with copies of the ordering/referring physician’s order for the studies. The physician must state the clinical indication/medical necessity for each test billed.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
999x Not Applicable
N/A

Revenue Codes

Code Description
99999 Not Applicable
N/A

CPT/HCPCS Codes

Group 1

(1 Code)
Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes
Code Description
80076 Hepatic function panel
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(370 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 80076.

Group 1 Codes
Code Description
B15.0 Hepatitis A with hepatic coma
B15.9 Hepatitis A without hepatic coma
B16.0 Acute hepatitis B with delta-agent with hepatic coma
B16.1 Acute hepatitis B with delta-agent without hepatic coma
B16.2 Acute hepatitis B without delta-agent with hepatic coma
B16.9 Acute hepatitis B without delta-agent and without hepatic coma
B17.0 Acute delta-(super) infection of hepatitis B carrier
B17.10 Acute hepatitis C without hepatic coma
B17.11 Acute hepatitis C with hepatic coma
B17.2 Acute hepatitis E
B17.8 Other specified acute viral hepatitis
B17.9 Acute viral hepatitis, unspecified
B18.0 Chronic viral hepatitis B with delta-agent
B18.1 Chronic viral hepatitis B without delta-agent
B18.2 Chronic viral hepatitis C
B18.8 Other chronic viral hepatitis
B18.9 Chronic viral hepatitis, unspecified
B19.0 Unspecified viral hepatitis with hepatic coma
B19.10 Unspecified viral hepatitis B without hepatic coma
B19.11 Unspecified viral hepatitis B with hepatic coma
B19.20 Unspecified viral hepatitis C without hepatic coma
B19.21 Unspecified viral hepatitis C with hepatic coma
B19.9 Unspecified viral hepatitis without hepatic coma
B20 Human immunodeficiency virus [HIV] disease
B25.1 Cytomegaloviral hepatitis
B58.1 Toxoplasma hepatitis
C16.0 Malignant neoplasm of cardia
C16.1 Malignant neoplasm of fundus of stomach
C16.2 Malignant neoplasm of body of stomach
C16.3 Malignant neoplasm of pyloric antrum
C16.4 Malignant neoplasm of pylorus
C16.5 Malignant neoplasm of lesser curvature of stomach, unspecified
C16.6 Malignant neoplasm of greater curvature of stomach, unspecified
C16.8 Malignant neoplasm of overlapping sites of stomach
C16.9 Malignant neoplasm of stomach, unspecified
C17.0 Malignant neoplasm of duodenum
C17.1 Malignant neoplasm of jejunum
C17.2 Malignant neoplasm of ileum
C17.3 Meckel's diverticulum, malignant
C17.8 Malignant neoplasm of overlapping sites of small intestine
C17.9 Malignant neoplasm of small intestine, unspecified
C18.0 Malignant neoplasm of cecum
C18.1 Malignant neoplasm of appendix
C18.2 Malignant neoplasm of ascending colon
C18.3 Malignant neoplasm of hepatic flexure
C18.4 Malignant neoplasm of transverse colon
C18.5 Malignant neoplasm of splenic flexure
C18.6 Malignant neoplasm of descending colon
C18.7 Malignant neoplasm of sigmoid colon
C18.8 Malignant neoplasm of overlapping sites of colon
C18.9 Malignant neoplasm of colon, unspecified
C19 Malignant neoplasm of rectosigmoid junction
C20 Malignant neoplasm of rectum
C21.0 Malignant neoplasm of anus, unspecified
C21.1 Malignant neoplasm of anal canal
C21.2 Malignant neoplasm of cloacogenic zone
C21.8 Malignant neoplasm of overlapping sites of rectum, anus and anal canal
C22.0 Liver cell carcinoma
C22.1 Intrahepatic bile duct carcinoma
C22.2 Hepatoblastoma
C22.3 Angiosarcoma of liver
C22.4 Other sarcomas of liver
C22.7 Other specified carcinomas of liver
C22.8 Malignant neoplasm of liver, primary, unspecified as to type
C22.9 Malignant neoplasm of liver, not specified as primary or secondary
C23 Malignant neoplasm of gallbladder
C24.0 Malignant neoplasm of extrahepatic bile duct
C24.1 Malignant neoplasm of ampulla of Vater
C24.8 Malignant neoplasm of overlapping sites of biliary tract
C24.9 Malignant neoplasm of biliary tract, unspecified
C25.0 Malignant neoplasm of head of pancreas
C25.1 Malignant neoplasm of body of pancreas
C25.2 Malignant neoplasm of tail of pancreas
C25.3 Malignant neoplasm of pancreatic duct
C25.4 Malignant neoplasm of endocrine pancreas
C25.7 Malignant neoplasm of other parts of pancreas
C25.8 Malignant neoplasm of overlapping sites of pancreas
C25.9 Malignant neoplasm of pancreas, unspecified
C33 Malignant neoplasm of trachea
C34.00 Malignant neoplasm of unspecified main bronchus
C34.01 Malignant neoplasm of right main bronchus
C34.02 Malignant neoplasm of left main bronchus
C34.10 Malignant neoplasm of upper lobe, unspecified bronchus or lung
C34.11 Malignant neoplasm of upper lobe, right bronchus or lung
C34.12 Malignant neoplasm of upper lobe, left bronchus or lung
C34.2 Malignant neoplasm of middle lobe, bronchus or lung
C34.30 Malignant neoplasm of lower lobe, unspecified bronchus or lung
C34.31 Malignant neoplasm of lower lobe, right bronchus or lung
C34.32 Malignant neoplasm of lower lobe, left bronchus or lung
C34.80 Malignant neoplasm of overlapping sites of unspecified bronchus and lung
C34.81 Malignant neoplasm of overlapping sites of right bronchus and lung
C34.82 Malignant neoplasm of overlapping sites of left bronchus and lung
C34.90 Malignant neoplasm of unspecified part of unspecified bronchus or lung
C34.91 Malignant neoplasm of unspecified part of right bronchus or lung
C34.92 Malignant neoplasm of unspecified part of left bronchus or lung
C43.0 Malignant melanoma of lip
C43.10 Malignant melanoma of unspecified eyelid, including canthus
C43.111 Malignant melanoma of right upper eyelid, including canthus
C43.112 Malignant melanoma of right lower eyelid, including canthus
C43.121 Malignant melanoma of left upper eyelid, including canthus
C43.122 Malignant melanoma of left lower eyelid, including canthus
C43.20 Malignant melanoma of unspecified ear and external auricular canal
C43.21 Malignant melanoma of right ear and external auricular canal
C43.22 Malignant melanoma of left ear and external auricular canal
C43.30 Malignant melanoma of unspecified part of face
C43.31 Malignant melanoma of nose
C43.39 Malignant melanoma of other parts of face
C43.4 Malignant melanoma of scalp and neck
C43.51 Malignant melanoma of anal skin
C43.52 Malignant melanoma of skin of breast
C43.59 Malignant melanoma of other part of trunk
C43.60 Malignant melanoma of unspecified upper limb, including shoulder
C43.61 Malignant melanoma of right upper limb, including shoulder
C43.62 Malignant melanoma of left upper limb, including shoulder
C43.70 Malignant melanoma of unspecified lower limb, including hip
C43.71 Malignant melanoma of right lower limb, including hip
C43.72 Malignant melanoma of left lower limb, including hip
C43.8 Malignant melanoma of overlapping sites of skin
C43.9 Malignant melanoma of skin, unspecified
C50.011 Malignant neoplasm of nipple and areola, right female breast
C50.012 Malignant neoplasm of nipple and areola, left female breast
C50.019 Malignant neoplasm of nipple and areola, unspecified female breast
C50.021 Malignant neoplasm of nipple and areola, right male breast
C50.022 Malignant neoplasm of nipple and areola, left male breast
C50.029 Malignant neoplasm of nipple and areola, unspecified male breast
C50.111 Malignant neoplasm of central portion of right female breast
C50.112 Malignant neoplasm of central portion of left female breast
C50.119 Malignant neoplasm of central portion of unspecified female breast
C50.121 Malignant neoplasm of central portion of right male breast
C50.122 Malignant neoplasm of central portion of left male breast
C50.129 Malignant neoplasm of central portion of unspecified male breast
C50.211 Malignant neoplasm of upper-inner quadrant of right female breast
C50.212 Malignant neoplasm of upper-inner quadrant of left female breast
C50.219 Malignant neoplasm of upper-inner quadrant of unspecified female breast
C50.221 Malignant neoplasm of upper-inner quadrant of right male breast
C50.222 Malignant neoplasm of upper-inner quadrant of left male breast
C50.229 Malignant neoplasm of upper-inner quadrant of unspecified male breast
C50.311 Malignant neoplasm of lower-inner quadrant of right female breast
C50.312 Malignant neoplasm of lower-inner quadrant of left female breast
C50.319 Malignant neoplasm of lower-inner quadrant of unspecified female breast
C50.321 Malignant neoplasm of lower-inner quadrant of right male breast
C50.322 Malignant neoplasm of lower-inner quadrant of left male breast
C50.329 Malignant neoplasm of lower-inner quadrant of unspecified male breast
C50.411 Malignant neoplasm of upper-outer quadrant of right female breast
C50.412 Malignant neoplasm of upper-outer quadrant of left female breast
C50.419 Malignant neoplasm of upper-outer quadrant of unspecified female breast
C50.421 Malignant neoplasm of upper-outer quadrant of right male breast
C50.422 Malignant neoplasm of upper-outer quadrant of left male breast
C50.429 Malignant neoplasm of upper-outer quadrant of unspecified male breast
C50.511 Malignant neoplasm of lower-outer quadrant of right female breast
C50.512 Malignant neoplasm of lower-outer quadrant of left female breast
C50.519 Malignant neoplasm of lower-outer quadrant of unspecified female breast
C50.521 Malignant neoplasm of lower-outer quadrant of right male breast
C50.522 Malignant neoplasm of lower-outer quadrant of left male breast
C50.529 Malignant neoplasm of lower-outer quadrant of unspecified male breast
C50.611 Malignant neoplasm of axillary tail of right female breast
C50.612 Malignant neoplasm of axillary tail of left female breast
C50.619 Malignant neoplasm of axillary tail of unspecified female breast
C50.621 Malignant neoplasm of axillary tail of right male breast
C50.622 Malignant neoplasm of axillary tail of left male breast
C50.629 Malignant neoplasm of axillary tail of unspecified male breast
C50.811 Malignant neoplasm of overlapping sites of right female breast
C50.812 Malignant neoplasm of overlapping sites of left female breast
C50.819 Malignant neoplasm of overlapping sites of unspecified female breast
C50.821 Malignant neoplasm of overlapping sites of right male breast
C50.822 Malignant neoplasm of overlapping sites of left male breast
C50.829 Malignant neoplasm of overlapping sites of unspecified male breast
C50.911 Malignant neoplasm of unspecified site of right female breast
C50.912 Malignant neoplasm of unspecified site of left female breast
C50.919 Malignant neoplasm of unspecified site of unspecified female breast
C50.921 Malignant neoplasm of unspecified site of right male breast
C50.922 Malignant neoplasm of unspecified site of left male breast
C50.929 Malignant neoplasm of unspecified site of unspecified male breast
C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct
D03.0 Melanoma in situ of lip
D03.10 Melanoma in situ of unspecified eyelid, including canthus
D03.111 Melanoma in situ of right upper eyelid, including canthus
D03.112 Melanoma in situ of right lower eyelid, including canthus
D03.121 Melanoma in situ of left upper eyelid, including canthus
D03.122 Melanoma in situ of left lower eyelid, including canthus
D03.20 Melanoma in situ of unspecified ear and external auricular canal
D03.21 Melanoma in situ of right ear and external auricular canal
D03.22 Melanoma in situ of left ear and external auricular canal
D03.30 Melanoma in situ of unspecified part of face
D03.39 Melanoma in situ of other parts of face
D03.4 Melanoma in situ of scalp and neck
D03.51 Melanoma in situ of anal skin
D03.52 Melanoma in situ of breast (skin) (soft tissue)
D03.59 Melanoma in situ of other part of trunk
D03.60 Melanoma in situ of unspecified upper limb, including shoulder
D03.61 Melanoma in situ of right upper limb, including shoulder
D03.62 Melanoma in situ of left upper limb, including shoulder
D03.70 Melanoma in situ of unspecified lower limb, including hip
D03.71 Melanoma in situ of right lower limb, including hip
D03.72 Melanoma in situ of left lower limb, including hip
D03.8 Melanoma in situ of other sites
D03.9 Melanoma in situ, unspecified
D68.8 Other specified coagulation defects
D68.9 Coagulation defect, unspecified
D69.6 Thrombocytopenia, unspecified
E80.4 Gilbert syndrome
E80.5 Crigler-Najjar syndrome
E80.6 Other disorders of bilirubin metabolism
E80.7 Disorder of bilirubin metabolism, unspecified
G93.31 Postviral fatigue syndrome
G93.32 Myalgic encephalomyelitis/chronic fatigue syndrome
G93.39 Other post infection and related fatigue syndromes
K70.0 Alcoholic fatty liver
K70.10 Alcoholic hepatitis without ascites
K70.11 Alcoholic hepatitis with ascites
K70.2 Alcoholic fibrosis and sclerosis of liver
K70.30 Alcoholic cirrhosis of liver without ascites
K70.31 Alcoholic cirrhosis of liver with ascites
K70.40 Alcoholic hepatic failure without coma
K70.41 Alcoholic hepatic failure with coma
K70.9 Alcoholic liver disease, unspecified
K71.0 Toxic liver disease with cholestasis
K71.10 Toxic liver disease with hepatic necrosis, without coma
K71.11 Toxic liver disease with hepatic necrosis, with coma
K71.2 Toxic liver disease with acute hepatitis
K71.3 Toxic liver disease with chronic persistent hepatitis
K71.4 Toxic liver disease with chronic lobular hepatitis
K71.50 Toxic liver disease with chronic active hepatitis without ascites
K71.51 Toxic liver disease with chronic active hepatitis with ascites
K71.6 Toxic liver disease with hepatitis, not elsewhere classified
K71.7 Toxic liver disease with fibrosis and cirrhosis of liver
K71.8 Toxic liver disease with other disorders of liver
K71.9 Toxic liver disease, unspecified
K72.00 Acute and subacute hepatic failure without coma
K72.01 Acute and subacute hepatic failure with coma
K72.10 Chronic hepatic failure without coma
K72.11 Chronic hepatic failure with coma
K72.90 Hepatic failure, unspecified without coma
K72.91 Hepatic failure, unspecified with coma
K73.0 Chronic persistent hepatitis, not elsewhere classified
K73.1 Chronic lobular hepatitis, not elsewhere classified
K73.2 Chronic active hepatitis, not elsewhere classified
K73.8 Other chronic hepatitis, not elsewhere classified
K73.9 Chronic hepatitis, unspecified
K74.01 Hepatic fibrosis, early fibrosis
K74.02 Hepatic fibrosis, advanced fibrosis
K74.1 Hepatic sclerosis
K74.2 Hepatic fibrosis with hepatic sclerosis
K74.3 Primary biliary cirrhosis
K74.4 Secondary biliary cirrhosis
K74.5 Biliary cirrhosis, unspecified
K74.60 Unspecified cirrhosis of liver
K74.69 Other cirrhosis of liver
K75.0 Abscess of liver
K75.1 Phlebitis of portal vein
K75.2 Nonspecific reactive hepatitis
K75.3 Granulomatous hepatitis, not elsewhere classified
K75.4 Autoimmune hepatitis
K75.81 Nonalcoholic steatohepatitis (NASH)
K75.89 Other specified inflammatory liver diseases
K75.9 Inflammatory liver disease, unspecified
K76.0 Fatty (change of) liver, not elsewhere classified
K76.1 Chronic passive congestion of liver
K76.2 Central hemorrhagic necrosis of liver
K76.3 Infarction of liver
K76.4 Peliosis hepatis
K76.5 Hepatic veno-occlusive disease
K76.6 Portal hypertension
K76.7 Hepatorenal syndrome
K76.81 Hepatopulmonary syndrome
K76.89 Other specified diseases of liver
K76.9 Liver disease, unspecified
K77 Liver disorders in diseases classified elsewhere
K80.00 Calculus of gallbladder with acute cholecystitis without obstruction
K80.01 Calculus of gallbladder with acute cholecystitis with obstruction
K80.10 Calculus of gallbladder with chronic cholecystitis without obstruction
K80.11 Calculus of gallbladder with chronic cholecystitis with obstruction
K80.12 Calculus of gallbladder with acute and chronic cholecystitis without obstruction
K80.13 Calculus of gallbladder with acute and chronic cholecystitis with obstruction
K80.18 Calculus of gallbladder with other cholecystitis without obstruction
K80.19 Calculus of gallbladder with other cholecystitis with obstruction
K80.20 Calculus of gallbladder without cholecystitis without obstruction
K80.21 Calculus of gallbladder without cholecystitis with obstruction
K80.30 Calculus of bile duct with cholangitis, unspecified, without obstruction
K80.31 Calculus of bile duct with cholangitis, unspecified, with obstruction
K80.32 Calculus of bile duct with acute cholangitis without obstruction
K80.33 Calculus of bile duct with acute cholangitis with obstruction
K80.34 Calculus of bile duct with chronic cholangitis without obstruction
K80.35 Calculus of bile duct with chronic cholangitis with obstruction
K80.36 Calculus of bile duct with acute and chronic cholangitis without obstruction
K80.37 Calculus of bile duct with acute and chronic cholangitis with obstruction
K80.40 Calculus of bile duct with cholecystitis, unspecified, without obstruction
K80.41 Calculus of bile duct with cholecystitis, unspecified, with obstruction
K80.42 Calculus of bile duct with acute cholecystitis without obstruction
K80.43 Calculus of bile duct with acute cholecystitis with obstruction
K80.44 Calculus of bile duct with chronic cholecystitis without obstruction
K80.45 Calculus of bile duct with chronic cholecystitis with obstruction
K80.46 Calculus of bile duct with acute and chronic cholecystitis without obstruction
K80.47 Calculus of bile duct with acute and chronic cholecystitis with obstruction
K80.50 Calculus of bile duct without cholangitis or cholecystitis without obstruction
K80.51 Calculus of bile duct without cholangitis or cholecystitis with obstruction
K80.60 Calculus of gallbladder and bile duct with cholecystitis, unspecified, without obstruction
K80.61 Calculus of gallbladder and bile duct with cholecystitis, unspecified, with obstruction
K80.62 Calculus of gallbladder and bile duct with acute cholecystitis without obstruction
K80.63 Calculus of gallbladder and bile duct with acute cholecystitis with obstruction
K80.64 Calculus of gallbladder and bile duct with chronic cholecystitis without obstruction
K80.65 Calculus of gallbladder and bile duct with chronic cholecystitis with obstruction
K80.66 Calculus of gallbladder and bile duct with acute and chronic cholecystitis without obstruction
K80.67 Calculus of gallbladder and bile duct with acute and chronic cholecystitis with obstruction
K80.70 Calculus of gallbladder and bile duct without cholecystitis without obstruction
K80.71 Calculus of gallbladder and bile duct without cholecystitis with obstruction
K80.80 Other cholelithiasis without obstruction
K80.81 Other cholelithiasis with obstruction
K81.0 Acute cholecystitis
K81.1 Chronic cholecystitis
K81.2 Acute cholecystitis with chronic cholecystitis
K81.9 Cholecystitis, unspecified
K82.0 Obstruction of gallbladder
K82.1 Hydrops of gallbladder
K82.2 Perforation of gallbladder
K82.3 Fistula of gallbladder
K82.4 Cholesterolosis of gallbladder
K82.8 Other specified diseases of gallbladder
K82.9 Disease of gallbladder, unspecified
K82.A1 Gangrene of gallbladder in cholecystitis
K82.A2 Perforation of gallbladder in cholecystitis
K83.01 Primary sclerosing cholangitis
K83.09 Other cholangitis
K83.1 Obstruction of bile duct
K83.2 Perforation of bile duct
K83.3 Fistula of bile duct
K83.4 Spasm of sphincter of Oddi
K83.5 Biliary cyst
K83.8 Other specified diseases of biliary tract
K83.9 Disease of biliary tract, unspecified
K87 Disorders of gallbladder, biliary tract and pancreas in diseases classified elsewhere
K91.5 Postcholecystectomy syndrome
K92.0 Hematemesis
K92.1 Melena
R10.11 Right upper quadrant pain
R10.13 Epigastric pain
R10.33 Periumbilical pain
R16.0 Hepatomegaly, not elsewhere classified
R16.1 Splenomegaly, not elsewhere classified
R16.2 Hepatomegaly with splenomegaly, not elsewhere classified
R17 Unspecified jaundice
R18.8 Other ascites
R53.0 Neoplastic (malignant) related fatigue
R53.1 Weakness
R53.81 Other malaise
R53.83 Other fatigue
R74.01 Elevation of levels of liver transaminase levels
R74.02 Elevation of levels of lactic acid dehydrogenase [LDH]
R74.8 Abnormal levels of other serum enzymes
R74.9 Abnormal serum enzyme level, unspecified
R82.2 Biliuria
R94.5 Abnormal results of liver function studies
T78.2XXA Anaphylactic shock, unspecified, initial encounter
T78.2XXD Anaphylactic shock, unspecified, subsequent encounter
T78.2XXS Anaphylactic shock, unspecified, sequela
T88.6XXA Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, initial encounter
T88.6XXD Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, subsequent encounter
T88.6XXS Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, sequela
Z09* Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
Z20.5* Contact with and (suspected) exposure to viral hepatitis
Z20.6* Contact with and (suspected) exposure to human immunodeficiency virus [HIV]
Z20.821* Contact with and (suspected) exposure to Zika virus
Z20.828* Contact with and (suspected) exposure to other viral communicable diseases
Z48.23* Encounter for aftercare following liver transplant
Z51.11* Encounter for antineoplastic chemotherapy
Z77.29* Contact with and (suspected) exposure to other hazardous substances
Z79.3* Long term (current) use of hormonal contraceptives
Z79.891* Long term (current) use of opiate analgesic
Z79.899* Other long term (current) drug therapy
Z94.4* Liver transplant status
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*These codes should not be billed as the primary diagnosis.

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
999x Not Applicable
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description
99999 Not Applicable
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/01/2022 R2

Article revised and published on 10/20/2022 effective for dates of service on and after 10/01/2022 to reflect the Annual ICD-10-CM Code Updates. ICD-10-CM code G93.3 has been deleted and therefore has been removed from ICD-10-CM Codes that Support Medical Necessity Group 1. The following ICD-10-CM codes have been added to ICD-10-CM Codes that Support Medical Necessity Group 1: G93.31; G93.32; G93.39.

10/01/2020 R1

Revision Number: 1
Publication: September 2020 Connection
LCR B2020-013

Explanation of revision: Based on CR 11845 (Annual 2021 ICD-10-CM Update), the “ICD-10 Codes that Support Medical Necessity/ Group 1 Codes:” section of this billing and coding article was revised to delete ICD-10-CM code K74.0 and R74.0 and replace them with K74.01, K74.02, R74.01 and R74.02. In addition, formatting changes have been made throughout the article. The effective date of this revision is based on date of service.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L33907 - Hepatic (Liver) Function Panel
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Updated On Effective Dates Status
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