What code covers a recheck of hepatitis C (HCV) in a patient treated 3 years ago?

Medical Coding for Hepatitis C Recheck After Treatment

For a patient treated for hepatitis C 3 years ago, the appropriate testing involves HCV RNA detection to assess for reinfection or late relapse, which would be coded as a diagnostic test for hepatitis C surveillance in a previously treated patient.

Clinical Context and Testing Rationale

Patients who achieved sustained virological response (SVR) after hepatitis C treatment require ongoing surveillance based on their fibrosis status and risk factors. 1

Post-Treatment Surveillance Guidelines

For non-cirrhotic patients with SVR:

• Testing should include HCV RNA at 48 weeks post-treatment 1
• If HCV RNA remains negative and ALT is normal, patients can be discharged as cured 1
• At 3 years post-treatment in a non-cirrhotic patient, routine HCV RNA testing is generally not indicated unless there are ongoing risk factors for reinfection 1

For cirrhotic patients with SVR:

• Indefinite surveillance for hepatocellular carcinoma (HCC) every 6 months is required 1
• Endoscopic surveillance for esophageal varices should continue 1
• HCC surveillance does not require repeat HCV RNA testing unless clinical suspicion for reinfection exists 1

When HCV RNA Testing is Indicated at 3 Years Post-Treatment

Annual HCV RNA assessment is recommended for patients with ongoing risk behaviors: 1

• People who inject drugs (PWID) 1
• Men who have sex with men (MSM) with ongoing risk behavior 1
• Reinfection risk is estimated at 1-5% per year in high-risk populations 1

Appropriate Coding Approach

The specific code selection depends on the clinical indication:

Primary Testing Code

• HCV RNA qualitative or quantitative PCR testing is the appropriate diagnostic test 1, 2
• This should be coded as surveillance testing in a patient with history of hepatitis C infection
• The test should use an FDA-approved assay with detection level ≤25 IU/mL 1

Supporting Diagnosis Codes

• History of hepatitis C infection (if SVR was achieved)
• Cirrhosis (if present) - justifies ongoing surveillance 1
• Current risk factors for reinfection (if applicable) 1

Important Clinical Caveats

Common pitfalls to avoid:

• Anti-HCV antibody testing alone is inappropriate at 3 years post-treatment, as antibodies persist indefinitely regardless of cure status 1
• HCV RNA testing is required to distinguish current infection from past resolved infection 1
• Quantitative viral load is not necessary unless active infection is detected 1

Additional considerations:

• If the patient has cirrhosis or advanced fibrosis (Metavir F3-F4), the recheck should include HCC surveillance imaging (ultrasound every 6 months), not just HCV RNA testing 1
• Patients without ongoing risk factors and without cirrhosis typically do not require HCV RNA testing at 3 years if they had documented SVR 1