Hepatology is the subspecialty of gastroenterology that focuses on diseases of the liver, gallbladder, biliary tree, and pancreas. Conditions such as hepatitis, cirrhosis, fatty liver disease (NAFLD/NASH), liver cancer, and transplant care require long-term management and often involve advanced diagnostics, imaging, lab tests, and medication protocols.
Because these services involve complex ICD-10 coding, frequent use of modifiers, and Medicare/commercial policy adherence, hepatology billing must be managed by experts. At Progressive RCM, we offer full-service hepatology billing solutions that reduce denials, support compliance, and increase revenue.
Key Challenges in Hepatology Billing
1. Chronic Disease Complexity
Most hepatology patients suffer from chronic liver conditions like:
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Hepatitis B/C
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Alcoholic or non-alcoholic liver disease
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Cirrhosis
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Portal hypertension
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Hepatocellular carcinoma (HCC)
These conditions require repeated visits, labs, imaging, and sometimes procedures, which must be billed correctly over long durations.
2. Accurate ICD-10 Coding
Hepatology demands specific, detailed diagnosis coding. Using a general term like “liver disease” can lead to denials. For example:
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K76.0 – Fatty liver, not elsewhere classified
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K70.30 – Alcoholic cirrhosis without ascites
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B18.2 – Chronic Hepatitis C
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C22.0 – Liver cell carcinoma
Choosing the wrong code may affect reimbursement, audits, or eligibility for advanced treatments.
3. Liver Biopsy and Imaging Billing
Hepatologists may perform or order:
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Liver biopsy
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Elastography
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CT/MRI with contrast
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FibroScan
These require correct CPT coding, pre-authorization, and documentation of medical necessity.
4. Medication & Injectable Drug Billing
Liver patients are often treated with high-cost medications (e.g., antivirals, immunosuppressants, chemotherapy). Billing these involves:
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Correct HCPCS (J-codes)
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Units administered
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Wastage reporting with JW modifier
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Prior authorizations and step therapy documentation
5. Coordination with Gastroenterology & Oncology
Hepatologists may share billing responsibility with other specialists. It’s critical to avoid duplicate billing and clarify the role and setting of each provider.
Common CPT, HCPCS & ICD-10 Codes in Hepatology
✅ CPT Codes:
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47000 – Liver biopsy, percutaneous
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76705 – Limited abdominal ultrasound
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76700 – Complete abdominal ultrasound
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91200 – Liver elastography
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74177 – CT abdomen/pelvis with contrast
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36415 – Blood draw
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99490 – Chronic care management (CCM)
✅ HCPCS (J-Codes) for Drugs:
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J8499 – Oral antiviral (unspecified)
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J0222 – Injection, Peginterferon alfa-2a
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J2505 – Injection, Pegfilgrastim
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J9201 – Gemcitabine (used for HCC)
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J9217 – Leuprolide acetate
✅ ICD-10 Diagnosis Codes:
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K76.0 – Non-alcoholic fatty liver
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K74.60 – Unspecified cirrhosis
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B18.2 – Chronic hepatitis C
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K71.7 – Toxic liver disease with fibrosis and cirrhosis
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C22.0 – Liver cancer
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R94.5 – Abnormal liver function studies
Hepatology Services That Require Detailed Billing
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Chronic liver disease consultations
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Liver biopsy (needle or surgical)
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FibroScan or liver elastography
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Hepatitis C antiviral treatment
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Liver function panel and viral load testing
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Chemotherapy for liver cancer
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Pre- and post-transplant assessments
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Screening for hepatocellular carcinoma
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Chronic care management for cirrhosis or hepatitis
Our Hepatology Billing Services
At Progressive RCM, we offer tailored hepatology billing solutions that support all aspects of liver care, from diagnostics to long-term treatment and medication management.
✅ Insurance Verification & Pre-Authorization
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Confirm coverage for liver biopsies, imaging, and medications
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Obtain prior authorizations for antivirals, CT/MRI, and biopsy
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Identify co-payments, deductibles, and plan restrictions
✅ Accurate Coding & Modifier Usage
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CPT/ICD-10 code assignment by certified coders
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Apply correct modifiers: 25 (E/M with procedure), 59 (distinct service), JW (drug wastage), etc.
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Prevent NCCI edit conflicts and bundling errors
✅ Drug Billing & Documentation
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Assign HCPCS J-codes for injectables or biologics
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Track drug inventory, units administered, and wasted quantities
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Ensure accurate charge capture and unit conversions
✅ Claim Submission & Reimbursement
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Submit clean claims within 24–48 hours
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Use claim scrubbers to detect missing or invalid codes
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Reconcile EOBs and ERAs, post payments promptly
✅ Denial Management & Appeals
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Identify root causes of denials: coding, auth, lack of medical necessity
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Prepare and submit timely appeals with supporting records
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Resolve underpayments and avoid timely filing losses
✅ Patient Billing & Financial Counseling
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Generate clear patient statements
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Offer support for insurance explanations and payment plans
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Educate patients and families on coverage options
✅ Monthly Reporting & Analytics
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Revenue by provider and procedure
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Denial trends and payer performance
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Drug usage, units billed, and reimbursement
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AR aging and patient collections
Why Choose Progressive RCM for Hepatology Billing?
✅ Specialized Knowledge in Liver Care Billing
Our team understands the complexities of hepatology, including liver diagnostics, chronic hepatitis management, and transplant billing.
✅ High-Cost Drug & Infusion Support
We specialize in J-code billing, JW modifiers, and prior authorizations for expensive liver treatments.
✅ Chronic Care & Preventive Billing
We help you capture revenue for CCM, AWV, and preventive screenings tied to hepatology.
✅ Audit-Ready Documentation & Compliance
Ensure your charts and coding stand up to Medicare and commercial audits, including MAC and RAC reviews.
✅ Customized Workflow
We integrate with your EMR/EHR system and adapt our process to your clinic’s size and needs — solo or multi-specialty.
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Final Thoughts
Hepatology billing is complex and critical — with chronic conditions, high-cost medications, transplant evaluations, and a wide range of diagnostics. Even a minor coding or authorization error can result in thousands of dollars in lost revenue.
At Progressive RCM, we make sure you bill accurately, get paid on time, and stay compliant with all regulations. From liver biopsies to antiviral therapy, we ensure nothing slips through the cracks.