LIVER PROFILE HEPATIC FUNCTION PANEL Test Code Test Name CPT LIVER Hepatic Function Panel 80076 LIVER Liver Profile 80076 HEPATIC FUNCTION PANEL ICD9 CODES THAT SUPPORT MEDICAL NECESSITY [MEDICARE POLICY #98RI-7-1] Page 1 of 32 Narrative Description ICD9 Abdominal area, including retroperitoneum; nonspecific abnormal findings on 793.6 radiological and other examination of body structure Abdominal or pelvic swelling, mass or lump; Epigastric 789.36 Abdominal or pelvic swelling, mass or lump; Generalized 789.37 Abdominal or pelvic swelling, mass or lump; left lower quadrant 789.34 Abdominal or pelvic swelling, mass or lump; left upper quadrant 789.32 Abdominal or pelvic swelling, mass or lump; Other specified site 789.39 Abdominal or pelvic swelling, mass or lump; Periumbilic 789.35 Abdominal or pelvic swelling, mass or lump; right lower quadrant 789.33 Abdominal or pelvic swelling, mass or lump; right upper quadrant 789.31 Abdominal or pelvic swelling, mass or lump; unspecified site 789.30 Abdominal pain; Epigastric 789.06 Abdominal pain; Generalized 789.07 Abdominal pain; left lower quadrant 789.04 Abdominal pain; left upper quadrant 789.02 Abdominal pain; Other specified site 789.09 Abdominal pain; Periumbilic 789.05 Abdominal pain; right lower quadrant 789.03 Abdominal pain; right upper quadrant 789.01 Abdominal pain; unspecified site 789.00 Abdominal rigidity; Epigastric 789.46 Abdominal rigidity; Generalized 789.47 Abdominal rigidity; left lower quadrant 789.44 Abdominal rigidity; left upper quadrant 789.42 Abdominal rigidity; Other specified site 789.49 Abdominal rigidity; Periumbilic 789.45 Abdominal rigidity; right lower quadrant 789.43 Abdominal rigidity; right upper quadrant 789.41 Abdominal rigidity; unspecified site 789.40 HEPATIC FUNCTION PANEL ICD9 CODES THAT SUPPORT MEDICAL NECESSITY [MEDICARE POLICY #98RI-7-1] Page 2 of 32 Abdominal tenderness; Epigastric 789.66 Abdominal tenderness; Generalized 789.67 Abdominal tenderness; left lower quadrant 789.64 Abdominal tenderness; left upper quadrant 789.62 Abdominal tenderness; Other specified site 789.69 Abdominal tenderness; Periumbilic 789.65 Abdominal tenderness; right lower quadrant 789.63 Abdominal tenderness; right upper quadrant 789.61 Abdominal tenderness; unspecified site 789.60 Abnormal involuntary movements 781.0 Abnormal serum enzyme levels, other nonspecific 790.5 Abnormality of gait 781.2 Acquired coagulation factor deficiency 286.7 Actinomycotic infections; Abdominal 039.2 Alcohol amnestic syndrome 291.1 Alcohol dementia; other 291.2 Alcohol dependence, other and unspecified; continuous 303.91 Alcohol dependence, other and unspecified; episodic 303.92 Alcohol induced sleep disorders 291.82 Alcohol withdrawal delirium 291.0 Alcohol withdrawal hallucinosis 291.3 Alcohol, excessive blood level of 790.3 Alcoholic induced psychotic disorder with delusions 291.5 Alcoholic cirrhosis of liver 571.2 Alcoholic fatty liver 571.0 Alcoholic hepatitis, Acute 571.1 Alcoholic induced mental disorders 291.89 Alcoholic intoxication, Acute; continuous 303.01 Alcoholic intoxication, Acute; episodic 303.02 Alcoholic intoxication, Acute; unspecified 303.00 HEPATIC FUNCTION PANEL ICD9 CODES THAT SUPPORT MEDICAL NECESSITY [MEDICARE POLICY #98RI-7-1] Page 3 of 32 Alcoholic liver damage, unspecified 571.3 Alcoholic polyneuropathy 357.5 Alcoholic psychosis, other specified; Alcohol withdrawal 291.81 Alcoholic psychosis, unspecified 291.9 Alpha-1 antitrypsin deficiency 273.4 Amebiasis, unspecified 006.9 Amebic brain abscess 006.5 Amebic dysentery without mention of abscess, Acute 006.0 Amebic infection of other sites 006.8 Amebic liver abscess 006.3 Amebic lung abscess 006.4 Amebic nondysenteric colitis 006.2 Amebic skin ulceration 006.6 Amino-acid metabolism, unspecified disorder of 270.9 Amyloidosis, unspecified 277.30 Anaphylactic shock due to adverse food reaction; Due to crustaceans 995.62 Anaphylactic shock due to adverse food reaction; Due to eggs 995.68 Anaphylactic shock due to adverse food reaction; Due to fish 995.65 Anaphylactic shock due to adverse food reaction; Due to food additives 995.66 Anaphylactic shock due to adverse food reaction; Due to fruits and vegetables 995.63 Anaphylactic shock due to adverse food reaction; Due to milk products 995.67 Anaphylactic shock due to adverse food reaction; Due to other specified food 995.69 Anaphylactic shock due to adverse food reaction; Due to peanuts 995.61 Anaphylactic shock due to adverse food reaction; Due to tree nuts and seeds 995.64 Anaphylactic shock due to adverse food reaction; Due to unspecified food 995.60 Anomalies of gallbladder, bile ducts, and liver; Other 751.69 Anomaly of gallbladder, bile ducts, and liver; Unspecified 751.60 Anorexia 783.0 Anthrax septicemia 022.3 Aphasia 784.3 HEPATIC FUNCTION PANEL ICD9 CODES THAT SUPPORT MEDICAL NECESSITY [MEDICARE POLICY #98RI-7-1] Page 4 of 32 Appendicitis, Acute; with generalized peritonitis 540.0 Appendicitis, Acute; with peritoneal abscess 540.1 Appendicitis, Acute; without mention of peritonitis 540.9 Aromatic amino-acid metabolism, other disturbances of 270.2 Ascites 789.5 Autoimmune disease, not elsewhere classified 279.4 Bacteremia 790.7 Bile duct, Fistula of 576.4 Bile duct, Obstruction of 576.2 Bile duct, Perforation of 576.3 Biliary atresia 751.61 Biliary cirrhosis 571.6 Biliary tract, Other specified disorders of 576.8 Biliary tract, Unspecified disorder of 576.9 Biliary tract; nonspecific abnormal findings on radiological and other examination 793.3 of body structure Bilirubin excretion, disorders of 277.4 Biliuria 791.4 Blood chemistry, other abnormal 790.6 Blood vessels of abdomen and pelvis, injury to; Abdominal Aorta 902.0 Blood vessels of abdomen and pelvis, injury to; Celiac and mesenteric arteries, 902.20 Celiac and mesenteric arteries, unspecified Blood vessels of abdomen and pelvis, injury to; Celiac and mesenteric arteries, 902.21 Gastric artery Blood vessels of abdomen and pelvis, injury to; Celiac and mesenteric arteries, 902.22 Hepatic artery Blood vessels of abdomen and pelvis, injury to; Celiac and mesenteric arteries, 902.23 Splenic artery Blood vessels of abdomen and pelvis, injury to; Celiac and mesenteric arteries, 902.24 Other specified branches of celiac axis Blood vessels of abdomen and pelvis, injury to; Celiac and mesenteric arteries, 902.25 Superior mesenteric artery (trunk) Blood vessels of abdomen and pelvis, injury to; Celiac and mesenteric arteries, 902.26 Primary branches of superior mesenteric artery Blood vessels of abdomen and pelvis, injury to; Celiac and mesenteric arteries, 902.27 Inferior mesenteric artery Blood vessels of abdomen and pelvis, injury to; Celiac and mesenteric arteries, 902.29 Other Blood vessels of abdomen and pelvis, injury to; Inferior vena cava, Inferior vena 902.10 cava, unspecified HEPATIC FUNCTION PANEL ICD9 CODES THAT SUPPORT MEDICAL NECESSITY [MEDICARE POLICY #98RI-7-1] Page 5 of 32 Blood vessels of abdomen and pelvis, injury to; Inferior vena cava, Hepatic veins 902.11 Blood vessels of abdomen and pelvis, injury to; Inferior vena cava, Other 902.19 Blood vessels of abdomen and pelvis, injury to; Other specified blood vessels of 902.87 abdomen and pelvis, Multiple blood vessels of abdomen and pelvis Blood vessels of abdomen and pelvis, injury to; Other specified blood vessels of 902.89 abdomen and pelvis, Other Blood vessels of abdomen and pelvis, injury to; Portal and splenic veins, Superior 902.31 mesenteric vein and primary subdivisions Blood vessels of abdomen and pelvis, injury to; Portal and splenic veins, Inferior 902.32 mesneteric vein Blood vessels of abdomen and pelvis, injury to; Portal and splenic veins, Portal vein 902.33 Blood vessels of abdomen and pelvis, injury to; Portal and splenic veins, Splenic 902.34 vein Blood vessels of abdomen and pelvis, injury to; Portal and splenic veins, Other 902.39 Blood vessels of abdomen and pelvis, injury to; Unspecified blood vessel of 902.9 abdomen and pelvis Bronchus, injury to, with open wound into cavity 862.31 Bronchus, injury to, without mention of open wound into cavity 862.21 Bubonic; Plague 020.0 Budd-Chiari syndrome 453.0 Cachexia 799.4 Calculus of bile duct with acute cholecystitis; with obstruction 574.31 Calculus of bile duct with acute cholecystitis; without mention of obstruction 574.30 Calculus of bile duct with other cholecystitis; with obstruction 574.41 Calculus of bile duct with other cholecystitis; without mention of obstruction 574.40 Calculus of bile duct without mention of cholecystitis; with obstruction 574.51 Calculus of bile duct without mention of cholecystitis; without mention of 574.50 obstruction Calculus of Gallbladder and bile duct with acute and chronic cholecystitis; without 574.80 mention of obstruction Calculus of Gallbladder and bile duct with acute and chronic cholecystitis; with 574.81 obstruction Calculus of Gallbladder and bile duct with acute cholecystitis; without mention of 574.60 obstruction Calculus of Gallbladder and bile duct with acute cholecystitis; with obstruction 574.61 Calculus of Gallbladder and bile duct with other cholecystitis; without mention of 574.70 obstruction Calculus of Gallbladder and bile duct with other cholecystitis; with obstruction 574.71 Calculus of Gallbladder and bile duct without cholecystitis; without mention of 574.90 obstruction HEPATIC FUNCTION PANEL ICD9 CODES THAT SUPPORT MEDICAL NECESSITY [MEDICARE POLICY #98RI-7-1] Page 6 of 32 Calculus of Gallbladder and bile duct without cholecystitis; with obstruction 574.91 Calculus of Gallbladder with acute cholecystitis;