Viral Hepatitis: Types, Symptoms, and Diagnosis Codes
August 01, 2019
With health officials declaring a hepatitis outbreak in South Carolina, infectious disease clinicians need to brush up their knowledge of documenting a diagnosis.
Viral hepatitis is a systemic infection that causes liver inflammation and damage. Evidence has shown that there is typically a higher number of outbreaks during the spring and summer months. Documenting and reporting hepatitis can be a confusing task for physicians as there are many ICD-10 codes available to classify hepatitis.
Hepatitis A, Hepatitis B, and Hepatitis C - Causes and Symptoms
The most common strains of hepatitis are A, B, and C. Hepatitis A is usually a short-term or acute infection, while hepatitis B and C tend to cause long-term or chronic illness. According to a March 2018 report from the U.S. Department of Health & Human Services (HHS), more than four million Americans from every state and all walks of life are infected with hepatitis B or hepatitis C, and the number of new infections is increasing drastically (www.hhs.gov/hepatitis/blog).
Hepatitis A: According to the CDC, hepatitis A is a growing threat. The number of people who contract the hepatitis A infection has been increasing. In fact, the increasing number of cases recently led the South Carolina Department of Health and Environmental Control (DHEC) to declare a statewide outbreak of hepatitis A.
Causes: The hepatitis A virus (HAV) is a communicable infectious liver disease that can cause mild to severe illness. It is spread through food or water contaminated by fecal matter. In addition to improper handling of food and poor hygiene, climatic and behavioral factors that cause HAV infection include summer travel to an endemic area and infection by swimming in contaminated water. As it is an acute condition, hepatitis A does not lead to chronic inflammation. Severity is usually mild, but in rare cases, hepatitis A can cause liver failure and even death. This usually occurs in adults older than age 50, and/or with people with other liver diseases and/or compromised immune systems. Getting vaccinated is the best way to prevent HAV infection and to avoid infecting others.
Liver inflammation or swelling, which occurs when the tissues of the body become injured or infected, can damage organs. As hepatitis A is an acute or short-term infection, it does not usually need treatment and people usually recover within a few weeks.
Symptoms: The HAV has an incubation period of about 28 days (range: 15–50 days). Among older children and adults, infection is typically symptomatic. Symptoms usually appear 2 to 6 weeks after contact with the virus. They may be relatively mild and resolve in a few weeks, but in some cases, can last up to 6 months.
The symptoms can include the following:
Dark yellow urine
Gray or clay-colored stools
Loss of appetite
Nausea and vomiting
Pain in the abdomen
Jaundice (yellowish eyes and skin)
Many children below age 6 do not have any symptoms.
Diagnosis and Treatment: Hepatitis A is diagnosed based on symptoms and a blood test. The blood test can detect antibodies to the hepatitis A virus and show the presence of an HAV infection.
In addition to medications that relieve the symptoms, treatment also includes resting, drinking plenty of liquids, and proper nutrition. Some people, however, may require a hospital stay.
Prevention: Hepatitis A Vaccination
The CDC recommends the hepatitis A vaccine for:
All children at age 1 year
Travelers to countries where hepatitis A is common
Family and caregivers of adoptees from countries with high incidence of hepatitis A
Men who have sexual encounters with other men
Liver disease (such as hepatitis B or hepatitis C or cirrhosis)
People with clotting factor disorders
People with direct contact with others who have hepatitis A
People experiencing homelessness
A recent Tampa Bay Times news report notes the CDC's observation that food handlers are not at an increased risk for hepatitis A and very rarely transmit the virus to customers. The report says that cooked food in restaurants poses little threat, because even if the food was contaminated, cooking it often kills off the virus. However, the actual problem is in the "bare handed serving" and not cooking. Hence the use of disposable, single use food handler gloves is recommended to prevent infection.
Hepatitis B: Caused by the hepatitis B virus (HBV), this serious liver condition is usually transmitted percutaneously (via a puncture/cut in the skin) or exposure to infected blood or body fluids. It can even be spread from mother to infant at birth. Acute illness can progress to a chronic infection and cause cirrhosis, liver failure, liver cancer, and even death. The hepatitis B vaccine protects against HBV infection and is recommended for all infants at birth (for children up to age 18) and adults that are considered high risk.
Hepatitis C: This liver infection is caused by the hepatitis C virus (HCV) and spread by contact with the blood of an infected person. According to the CDC Hepatitis C Guidelines, HCV is the most common chronic bloodborne pathogen in the U.S., and about 2.7-3.9 million people are chronically infected. Modes of transmission include needles shared among drug users, blood transfusions, hemodialysis, and needle sticks. Though considered an acute illness, HCV infection has the potential to turn into a dormant, chronic infection that can result in cirrhosis, liver failure, liver cancer, and death. There is no vaccine available that can protect against hepatitis C.
2019 ICD-10 Codes to Report Viral Hepatitis
Viral Hepatitis is reported with ICD- 10 codes in the B15-B19 range:
Viral Hepatitis - B15-B19
Excludes: cytomegaloviral hepatitis (B25.1); herpesviral [herpes simplex] hepatitis (B00.8); and sequelae of viral hepatitis (B94.2)
B15 Acute hepatitis A B15.0 Hepatitis A with hepatic coma B15.9 Hepatitis A without hepatic coma Hepatitis A (acute)(viral) NOS
B16 Acute hepatitis B 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 Hepatitis B (acute) (viral) NOS B17 Other acute viral hepatitis B17.0 Acute delta-(super) infection of hepatitis B carrier B17.1 Acute hepatitis C B17.10 Acute hepatitis C without hepatic coma Acute hepatitis C NOS B17.11 Acute hepatitis C with hepatic coma B17.2 Acute hepatitis E B17.8 Other specified acute viral hepatitis Hepatitis non-A non-B (acute) (viral) NEC B17.9 Acute viral hepatitis, unspecified Acute hepatitis NOS Acute infectious hepatitis NOS B18 Chronic viral hepatitis Includes: Carrier of viral hepatitis B18.0 Chronic viral hepatitis B with delta-agent B18.1 Chronic viral hepatitis B without delta-agent Carrier of viral hepatitis B Chronic (viral) hepatitis B B18.2 Chronic viral hepatitis C Carrier of viral hepatitis C B18.8 Other chronic viral hepatitis Carrier of other viral hepatitis B18.9 Chronic viral hepatitis, unspecified Carrier of unspecified viral hepatitis B19 Unspecified viral hepatitis B19.0 Unspecified viral hepatitis with hepatic coma B19.1 Unspecified viral hepatitis B19.10 Unspecified viral hepatitis B without hepatic coma Unspecified viral hepatitis B NOS B19.11 Unspecified viral hepatitis B with hepatic coma B19.2 Unspecified viral hepatitis C B19.20 Unspecified viral hepatitis C without hepatic coma Viral hepatitis C NOS B19.21 Unspecified viral hepatitis C with hepatic coma B19.9 Unspecified viral hepatitis without hepatic coma Viral hepatitis NOS
Battling Viral Hepatitis -Challenges Involved
The HHS.gov blog identifies several challenges to overcome in order to win the battle against viral hepatitis.
The first is the opioid epidemic that is gripping the country. The rise in new HBV and HCV infections are linked to increasing intravenous drug abuse, specifically opioids. Another problem is that many people with HBV or HCV infection remain unaware of their infection, and are not getting treatment. Timely diagnosis and treatment can prevent the disease progression and liver damage, and lower the risk of spreading the virus to others. The report notes that one in four people who are chronically infected with hepatitis B will die prematurely due to lack of timely access to care. Another challenge is the increase in HCV infection among pregnant women, which puts more babies at risk. Finally, the costs for treating these diseases will increase if steps are not taken to reverse the trends of increasing infections.
The National Viral Hepatitis 2017–2020 (Action Plan) is the roadmap for addressing viral hepatitis in the United States. The author stresses the importance of helping stakeholders better understand the seriousness of the problem so that they can work to overcome the barriers in the fight against viral hepatitis. With the growing number of infections, infectious disease clinicians need to be very vigilant to screen and manage patients to help control the spread of all forms of hepatitis and avoid a severe outbreak. Medical coding companies can help with proper ICD-10 code assignment to document diagnoses correctly which is crucial to receiving appropriate reimbursement.
Natalie Tornese, CPC, is a Senior Solutions Manager responsible for Practice and Revenue Cycle Management at MOS. She brings 25 years of healthcare management experience to the company. Natalie has worked in varied leadership roles with practices and specialties. Her primary focus is revenue cycle management with an emphasis on Medical Billing, Coding, and Insurance Verification Management. Natalie also holds a CPC certification by the American Academy of Professional coders (AAPC). She has written numerous articles on all aspects of Practice Management, and presently manages a large team focused on Medical Billing, Medical Coding, Verification and Authorization services for MOS (www.outsourcestrategies.com).