CHC LABS INC.                       

Hepatic (Liver) Function Panel

(80076)

042                    Human immunodeficiency virus (HIV) disease

070.0-070.9        Viral hepatitis

130.5                 Hepatitis due to toxoplasmosis

151.0-150.9        Malignant neoplasm of stomach

152.0-152.9        Malignant neoplasm of small intestine, including duodenum

153.0.153.9        Malignant neoplasm of colon

154.0-154.8        Malignant neoplasm of rectum, rectosigmoid junction, and anus

155.0-155.2        Malignant neoplasm of liver and intrahepatic bile ducts

156.0-156.9        Malignant neoplasm of gallbladder and extrahepatic bile ducts

157.0-157.9        Malignant neoplasm of pancreas

162.0-162.9        Malignant neoplasm of trachea, bronchus, and lung

172.0-172.9        Malignant neoplasm of skin   

174.0-174.9        Malignant neoplasm of female breast

175.0-175.9        Malignant neoplasm of male breast

197.7                 Secondary malignant neoplasm of respiratory and digestive systems, liver,

                         specified as secondary

277.4                 Disorders of bilirubin excreation

571.0-571.9        Chronic liver disease cirrhosis

572.0-572.8        Liver abscess and sequelae of chronic liver disease

573.0-573.9        Other disorders of liver

574.00-574.91     Cholethiasis

575.0-575.9        Other disorders of gallbladder

576.0-576.9        Other disorders of biliary tract

782.4                 Jaundice, unspecified, not of newborn

789.01               Abdominal pain, right upper quadrant

789.05               Abdominal pain, periumbilic

789.06               Abdominal pain, epigastric

789.1                 Hepatomegaly

790.4                 Nonspecific elevation of levels of transaminase or lactic acide deydrogenase (LDH)

790.5                 Other nonspecific abnormal serum enzyme levels

794.8                 Nonspecific abnormal results of function studies, liver

995.0                 Other anaphylactic shock

V42.7                 Organ or Tissue replaced by transplant, liver

V58.1                 Encounter for other and unspecified procedures and aftercare, chemotherapy

V58.69               Long-term (current) use of other medications

V67.51               Following completed treatment with high-risk medications, not elsewhere classified

  This policy has been duplicated from the most current Medicare National Coverage Determination or Local Medical Review Policy available at the time this booklet was printed in October 2005. Medicare will consider this test(s) medically reasonable and necessary only if the test(s) was performed for any of the diagnoses/conditions listed on this page. This information is subject to change without notice, and Covenant Health Care Labs (CHC) is not responsible for consequences that may result from using such information. CHC is not indicating one code is more acceptable than another, and that selected codes should reflect the patients actual medical condition as noted in their medical record.