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The CPT® Code 81596 pertains to a laboratory test specifically designed for the assessment of chronic hepatitis C virus (HCV) infection. This test evaluates the presence of fibrosis and necroinflammatory activity in the liver, providing critical insights into the liver's health without the need for invasive procedures such as liver biopsy. The test measures six key biochemical markers: alanine aminotransaminase (ALT), A2-macroglobulin, apolipoprotein A-1, total bilirubin, gamma-glutamyltransferase (GGT), and haptoglobin. Each of these biomarkers plays a significant role in indicating liver function and damage. The results are interpreted through a prognostic algorithm that incorporates the patient's age, gender, and serum levels of the biomarkers, yielding scores that categorize the extent of fibrosis and inflammatory activity. Specifically, the fibrotic score ranges from 0.00 to 1.00, correlating to a stage score from F0 (no fibrosis) to F4 (severe fibrosis or cirrhosis). Similarly, the inflammatory activity score also ranges from 0.00 to 1.00, with stage scores from A0 (no activity) to A3 (severe activity). This comprehensive approach allows healthcare providers to monitor the progression of liver disease in patients with chronic HCV infection effectively.
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The CPT® Code 81596 is indicated for use in patients diagnosed with chronic hepatitis C virus (HCV) infection. The test is performed to assess the degree of liver fibrosis and necroinflammatory activity, which are critical factors in determining the progression of liver disease. The following conditions warrant the use of this test:
The procedure for CPT® Code 81596 involves several key steps to ensure accurate assessment of liver fibrosis and necroinflammatory activity. The following procedural steps are outlined:
After the procedure associated with CPT® Code 81596, there are no specific post-procedure care requirements as the test is non-invasive and involves only a blood draw. Patients can typically resume their normal activities immediately following the blood sample collection. However, it is essential for healthcare providers to discuss the results with the patient once they are available, as these results will inform the management of their chronic hepatitis C infection. Follow-up appointments may be necessary to monitor liver health and adjust treatment plans based on the findings from the test.
| Short Descr | NFCT DS CHRNC HCV 6 ASSAYS | Medium Descr | NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR | Long Descr | 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 | Status Code | Statutory Exclusion (from MPFS, may be paid under other methodologies) | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | CLIA Waived (QW) | No | APC Status Indicator | Service Paid under Fee Schedule or Payment System other than OPPS | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| 90 | Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 91 | Repeat clinical diagnostic laboratory test: in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. this modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). this modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient. | GA | Waiver of liability statement issued as required by payer policy, individual case | GW | Service not related to the hospice patient's terminal condition | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2019-01-01 | Added | Added |
| 2018-06-12 | Added | Code added. |
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