Hepatitis

HEPATITIS and ICD 10 CODES

What is Hepatitis?

Hepatitis is the inflammation of the liver. The word hepatitis is derived from Greek word hepas means liver and itis means inflammation. The hepatitis is the inflammation of the liver that is caused by virus.

Many different types of infections of hepatitis are: Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, Hepatitis E

ICD – 10 CM HEPATITIS CODES

Acute hepatitis  ‘A’

Acute hepatitis ‘A’ with hepatic coma – B15.0

Acute hepatitis ‘A’ without hepatic coma – B15.9

Acute hepatitis  ‘B’

Acute hepatitis ‘B’  with delta-agent  with hepatic coma – B16.0

Acute hepatitis ‘B’  with delta-agent  without  hepatic coma – B16.1

Acute hepatitis ‘B’  without delta-agent  with hepatic coma – B16.2

Acute hepatitis ‘B’  without delta-agent and  without hepatic coma – B16.9

Other acute viral hepatitis – B17

Acute delta – (super) infection of hepatitis B carrier – B17.0

Acute hepatitis  ‘C’

Acute hepatitis ‘C’ without hepatic coma – B17.10

Acute hepatitis ‘C’ with hepatic coma – B17.11

Acute hepatitis EB17.2

Other specified acute viral hepatitisB17.8

Acute viral hepatitis, unspecifiedB17.9

Chronic viral hepatitis

Chronic viral hepatitis ‘B’ with delta- agent – B18.0

Chronic viral hepatitis ‘Bwithout delta- agent – B18.1

Chronic viral hepatitis ‘C’ B18.2

Other chronic viral hepatitis – B18.8

Chronic viral hepatitis, unspecified – B18.9

Unspecified viral hepatitis  with hepatic comaB19.0

Unspecified viral hepatitis ‘B’  without  hepatic coma – B19.10

Unspecified viral hepatitis ‘B’  with  hepatic coma – B19.11

Unspecified viral hepatitis ‘C’ without hepatic coma – B19.20

Unspecified viral hepatitis ‘C’ with hepatic coma – B19.21

Unspecified viral hepatitis without hepatic coma – B19.9

Types of virus are: Cytomegalo virus (CMV), Epstein-Barr virus (EBV), Herpes simplex virus (HSV)
Hepatitis virus:
Type: Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, Hepatitis E
Incubation: 30 days, 90 days, 40 days, 45 days, 50 days
Route Faeco,  oral, parenteral, parenteral, parenteral,  faeco, oral.
Severity: Mild, Severe, Mild, Mild to severe, Mild
Chronicity: None, 10%, 50-60%, 5%, None
Faeco oral: the infected person excretes feces infect water or food and may infect new person
Parenteral: Subcutaneous, Intravenous, Intramuscular routes for transmission
EPIDEMIOLOGY:
Hepatitis A:
According to the center for disease control and prevention (CDC),4,448 repeated cases of acute clinical hepatitis A infection in the united states in 2005 were the lowest in recorded history. Although vaccine preventable, HAV continues to be one of the most commonly reported infections.
Unvaccinated children acquiring HAV infections abroad can serve as reservoirs of the virus upon return to the united states, even while remaining clinically asymptomatic themselves. Hepatitis A is an acute, short-term disease, while Hepatitis B, C and D are most likely to become ongoing and chronic. Hepatitis E is usually acute but dangerous in pregnant women.
Hepatitis B:
Although a vaccine was made available in 1981, Hepatitis B virus has acutely infected more than 2 billion people globally, leading to the chronic infection in more than 350 million people.
More than 1 million people per year die as a result of liver cirrhosis and hepatocellular carcinoma. In united states, Hepatitis B virus is the second most common type of acute virus hepatitis and third most reported preventable disease, Second only to Hepatitis A virus
Hepatitis C: Hepatitis C Virus is the most common blood-borne pathogen. In U.S approximately 3.2 million people are chronically infected with Hepatitis C virus.
An estimated 20,000 new infections occurred in 2005
Hepatitis D: At least 5% of people with chronic Hepatitis B virus infection are co-infected with Hepatitis D virus, resulting in a total of 15-20 million persons infected with Hepatitis D virus worldwide. However, this is a broad global estimation since many countries will not report the prevalence of Hepatitis D virus.

Hepatitis E: This hepatitis E caused approximately 44000 deaths in 2015. Accounting for 3.3% of mortality due to viral hepatitis. This is most common in east and South Asia.

CAUSES OF NON-INFECTIOUS HEPATITIS:
Alcohol and other toxins: Heavy alcohol consumption can cause liver damage and inflammation. This is referred as alcohol hepatitis. This alcohol directly injures the cells of liver, permanent damage may cause liver failure and cirrhosis, thickening and scarring of liver. And other toxic causes of hepatitis include the overuse of medicines and exposure to poisons.
Autoimmune system response: In some cases, the immune system mistakes the liver as a harmful object and attacks own cells. This is three times more common in women than in men.
COMMON SYMPTOMS: The infectious forms of hepatitis that are chronic, like Hepatitis B and C we may not observe any symptoms in beginning. Symptoms may not occur until the damage affects liver functions.
Fatigue
Flu like symptoms
Dark urination
Pale stool
Abdominal pain
Loss of appetite
Weight loss
Yellow skin and eyes which may be a sign for jaundice
Chronic hepatitis develops slowly, so we can’t observe most of these symptoms.
COMPLICATIONS OF HEPATITIS:
Chronic hepatitis B or C can lead to serious health problems. The virus mainly affects the liver, people with chronic hepatitis B or C are at risk for:
Chronic liver disease, Cirrhosis, Liver cancer
When liver stops functioning normally, liver failure can occur. The complications of liver failure include:
Bleeding disorders
Ascites
Portal hypertension
Kidney failure
Hepatic encephalopathy
Hepatocellular carcinoma
Death

People with chronic hepatitis B and C 

DIAGNOSIS:
The hepatitis can be diagnosed by following ways:
  • History and physical examination by pressing the abdomen gently to chest the pain and tenderness and check the color of skin and eyes.
  • Liver function tests
  • Blood test
  • Ultrasound
  • Liver biopsy
TREATMENT:
Treatment options for hepatitis are determined by the type of hepatitis and whether the infection is chronic or acute.
Hepatitis A: This usually doesn’t require treatment because it is a short term illness. Bed rest is recommended if symptoms cause discomfort. The Hepatitis A vaccine is available to prevent infection. The vaccination is given between age 12-18 months. It is a series of two vaccines. vaccination for hepatitis A is also available for adults and combined with Hepatitis B vaccine.
Hepatitis B: Acute hepatitis B doesn’t require specific treatment. Chronic treatment of Hepatitis B with anti viral medications. This form of treatment may be costly because it must be continued for several months or years. Treatment for chronic hepatitis B requires regular medications, evaluation and monitoring to determine if the virus is responding to treatment.
Hepatitis C: Anti viral medications are used to treat acute and chronic forms of Hepatitis C people who develop chronic hepatitis c are typically treated with a combination of antiviral drug therapies. Patients having cirrhosis or liver disease result in chronic hepatitis C. This may lead to liver transplantation.
Hepatitis D: No anti viral medication exist for the treatment for Hepatitis D. According to a drug called alpha interferon can be used to treat hepatitis D. This can be prevented by vaccination of hepatitis B.

Hepatitis E: No specific medical therapies are available for treating hepatitis E, Because the infection is often acute, typically resolves on its own patient with this type of infection are advised to get adequate rest, drinking plenty of fluids, get enouugh nutrients, avoid alcohol. Pregnant women having this infection require close monitoring and care.

AUTO IMMUNE HEPATITIS:
Corticosteroids like prednisone or budesonide are important in th early treatment of auto immune hepatitis. Azathioprine that supress the immune system, is included in the treatment it can be used with or without steroids. Other immune supplements like Mycophenolate, Tacrolimus, Cyclosporins can also be used as alternatives to azathioprin treatment. 
PREVENTION:
MAINTAINANCE OF HYGIENE:
Practicing good hygiene is one way to avoid contracting hepatitis A and E. If you’re travelling to  a developing country. we must avoid:
Local water               
Ice
Raw or under cooked shellfish and oysters
Raw fruit and vegetables
Hepatitis B,C and D which are contracted through contaminated blood can be prevented by:
Not sharing drug needled
Not sharing razors
Not using someone else’s toothbrush
Not touching spilled blood
Hepatitis B and C can spread through sexual intercourse and intimate sexual contact. Practicing safe sex by using condoms and dental dams can help decrease the risk of infection. 
Vaccines: The use of vaccines is important key to prevent hepatitis. Vaccinations are available to prevent the development of hepatitis A and B.

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