Introduction - PDF document

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?????????????????????????????????????????????????? 13%'$(13????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? @!Introduction Hepatitisviru(HCV)infectionismajorpublichealthissuewithanestimated2.4millionestimatedreacheddiseaseLeftandand anareis ThisHepatitis C Provider Toolkitwas prepared by the Indiana State Department of Health for primary care and public health professionals to use as a guidance for HCV testing and diagnosis.Thistoolkitwill provide the following informationand resources for: HCV esting ecommendationsInterpretation of ResultsHepatitis C Screening and Diagnosis CodingTreatment AccessProvider ResourcesPatient Resources Sherika * +&41&(3!7,(!A23&.3&!+,41(,5!.4:!8(&-&412,4!'11%3BCCDDD?=:=?/,-C'&%.12123C'=-C'=-7.E?'19 � +&41&(3!7,(!A23&.3&!+,41(,5!.4:!8(&-&412,4!'11%3BCCDDD?=:=?/,-C9&:2.C(&5&.3&3C�F*GC%FHFI'&%=9,(1.521$?'195 @ +&41&(3!7,(!A23&.3&!+,41(,5!.4:!8(&-&412,4!'11%3BCCDDD?=:=?/,-C4=''31%C4&D3(,,9C:,=3C7.=13'&&13C-2(.5'&%52-&(=.4=&(?%:7 I! (PWID) theCDC, Mostpeop

lewithhepatitisdonotknowtheyareinfected.ThenlywatoknowpersonisComplicationsfrom HCVforthe virusase CentersforDiseaseControlandPreventionDC)2012,theCDCssuedrecommendationsfoontimehepatitisscreeningforalladultsbornfrom1945through1965regardlessofrisk.Thisrecommendationwasanexpansiontotheexistingriskbaseguidelines.Therecommendationsalsoincludereferraltocareandtreamentandriefscreeningfor alcoholfor anyoneidentifiedasHCVpositive.U.S.PreventiveServicesTaskForceUSPSTF)4,6TheUSPSTFdeterminedthatHCVscreeningamongpersonsallagesincreasedrisandonetimscreeningforadultsbornduring1945asbeneficialandgaveitgradeÒBÓTheUSPSTFgradesrecommendationsbasedonthevidenceofboththebenefitsandtheharmsoftheserviceandanassessmenthebalance.ederallawrequiresthat privateinsuranceedicaidplanscoverUSPSTForrecommendedserviceswithoutcostaring.ThefinalUSPSTFrecommendationsstatementcanbeviewedhere:https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/hepatitis-c-screening HepatitisCentersforDiseaseContrandPreventionhttps://www.cdc.gov/hepatitis/hcv/guidelinesc.htmU.S.PreventiveService

TaskForcehttps://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/hepatitis-c-screening#Pod1AASLDhttps://www.hcvguidelines.org/evaluate/testingndinkage H! Risk factor/Risk exposure USPSTF CDC AASLD Born between 1945 and 1965 ! ! ! Current or past injection drug use ! ! ! Intranasal drug use ! !* ! Other non - injection illegal drug use !* Receipt of tattoo in an unregulated setting ! !* ! Receipt of blood transfusion and/or organ transplant before 1992 ! ! Receipt of clotting factor concentrates before 1987 ! ! Ever been incarcerated ! ! Children born to HCVpositive infected mothers ! ! ! Persons on longterm hemodialysis ! ! ! Unexplained chronic liver disease and/or chronic hepatitis ! Elevated alanine aminotransferase (ALT) levels ! ! HIVinfected ! ! NonHIV infected persons before starting preexposure prophylaxis (PreP) ! *Mentionedbut described as uncertain nee ThemericanAssociationfortheStudyofLiverDisease(AASLD)andtheInfectiousDiseasesSocietyofAmerica(IDSA)4,7 offersguidanceforformedicaandbehavior

sAASLD/IDSAÕsecommendationsforhttps://www.hcvguidelines.org G!AssurepaticonfidentialityListenyourpatientAcceptthatyourpatient/clientÕsvaluesmay differentfromyourownAvoidjudging a patient/clientÕsrsonalbehaviorssensitiveexpressionsandgestures(bothyoursandyourpatient/clietÕs)Helpyourpatientsexploretheiroptionsforredcingstopingunsafesexual substanceusingbehaviors Were you born between 1945 and 965Do you inject drugs?Have you ever injected, even if just once?Have you ever received a blood transfusion or organ transplant before July 1992?Have you ever inhaled (snorted) drugs?Have you ever gotten a tattoo or piercing from anyone other than a licensedprofessional?Have you ever been to jail or prison?Have you ever received blood clotting factor concentrate before 1987?Are you HIVpositive?Have you had sex with someone whoyou know s hepatitis C?Have you been exposed to blood or had an accidental needlestick on the jobWas your mother infected with hepatitis C when you were born?atient who answer yes to any of these questionsshould be educated on HCV and other infections for which they m

ay be at risk. Once the patient has been identified as at riskhe or sheshould be tested Sexpracticesanddrugaredifficulttopicsdiscussespeciallywithyouth.It ortantprovideeveryonewithinformationhowprotectthemselves.Herearesometipskeepinmindwhentalkingwithpatiens/clientsaboutpracticingsafesex andreducingstoppingsubstanceuse. Adapted from the ISDH "Viral Hepatitis Resource and Services Directory" https://www.in.gov/isdh/filesIndianaResourceDirectory2006.pdf K!nonreactive negative antibody test means that the patientdoes not havehepatitis C. No further testing is needed, unless the patient has been recentlyexposed. If exposure to HCV was in the lastmonths, they will need to be testedagain.reactive or positive antibody test mean that the patienthas been infected witHCV at some point in time. A reactive antibody test does not indicate currentfection. urther testing is required to diagnose HCV infection.Hepatitis C Diagnostic TestIf the antiHCV result is reactive, it should be followed by a test to detect HCV RNA. Another name used for this test is polymerase chain reaction or PCR. HCV RN

A can be detected as early as twothreeweeks after exposure to HCV infection. If HCVRNA isnot detected, the patient does not have HCV infection.If HCVRNA isdetectedthe patient is infected with HCV. The presence of HCV inthe blood indicates HCV infection.If a patient was exposed in the last sixmonths,testing for HCV RNA or followup testing for HCV antibody is recommended.Please refer to Recommended Testing Sequence for Identifying Current Hepatitis C Virus Infectionand Interpretation of Results of Test for Hepatitis C Virus Infection and Further Actionfor additional information. identified as someone who y be infectionincludingantibodies,for(antiisdetermineafterafter L! Adapted from the NACCHO “Hepatitis C PublicDetailing * canincludedecisionfollow ConsultthemostupdateHCVpreventionantreatmentguidelinesat (BabyfactorsV. People at-risk can include wave everin the past allrisk factor infectionsperformingositive. onfirmatoryto a medical provider reduction information. FollowupthantibodysitivepatientsinyourpracticetoensuretheyreceivenfirmatorRNAtestandarelinkedtocareortreatme

nt.Important:Positivehepatitis Bandhepatitislabsshouldbereportedtothelocalhealth department ortheIndianaStateDepartment ofHealth(ISDH),asdetailedintheCommunicableDiseaseReportingRule,Title410,Article1,Rule2.5theIndianaAdministrativeCode.ISDHrequiresthathospitals,healthcareproviderandlaboratoriesreportpositivehepatitislabsimmediatelyifthepatientispregnant.Allotherpositive hepatitislabsmustbereportedwithin72hours.Positivehepatitisresultsmustbereportedwithinfivebusinessday,thisincludesHCVrapidantibodytesresultsTheCommunicableDiseaseReportingRuleandtheConfidentialReportofommunicableDiseasesormcanbefoundat:https://www.in.gov/isdh/25366.htm S! AmericanMedicalAll CPT® Code Description Hepatitis C Screening Tests 86803Hepatitis C antibody 86804Hepatitis C antibody, confirmatory test (with reflex) G0472Hepatitis C screening, for an individual at high risk and other covered indication Hepatitis C Diagnostic Tests 87520Hepatitis C RNA; direct probe technique 87521Hepatitis C RNA; amplified probe technique 87522Hepatitis C RNA; quantification 87902Hepatitis C Virus genotype analysis Other

Hepatitisrelated Tests 86708Hepatitis A antibody (HAAb); total 86709Hepatitis A antibody (HAAb), IgM antibody 86704Hepatitis B core antibody (HBcAb); total 86705Hepatitis B core antibody (HbcAb); IgM 86706Hepatitis B surface antibody (HbsAb) 87340Hepatitis B surface antigen (HBsAg) detection 80074Acute hepatitis panel This panel must include the following: Hepatitis A antibody, IgM antibody (86709) Hepatitis B core antibody (HBcAb), IgM antibody (86705) Hepatitis B surface antigen (HBsAg) (87340) Hepatitis C antibody (86803) atiti *F ICD Diagnosis Codes Description HCV Codes B17.10Acute hepatitis C without hepatic coma B18.2 Chronic hepatitis C without hepatitis coma B19.20Unspecified viral hepatitis C without hepatic coma B19.21Unspecified viral hepatitis C with hepatic coma B17. 8Other specified acute viral hepatitis Z22.50Carrier of unspecified viral hepatitis Z22.52Carrier of viral hepatitis C Z22.59Carrier of other viral hepatitis Other hepatitisrelated ICD10 codes B15.9Acute hepatitis A without hepatic coma B18.0Chronic hepatitis B with deltaagent B18.1Chronic viral he

patitis B without deltaagent Z20.5Contact with and (suspected) exposure to viral hepatitis B18.8Other chronic viral hepatitis B19.9Chronic viral hepatitis unspecified B19.0Unspecified viral hepatitis with hepatic coma B19.9Unspecified viral hepatitis without hepatic coma Z86.19Personal history of other infectious diseases Other ICD10 codes Z72.51Highrisk sexual behavior, heterosexual Z72.52Highrisk sexual behavior, homosexual Z72.53Highrisk sexual behavior, bisexual Z00.00Routine medical examination of adult; Encounter for laboratory as part of general medical examination Z00.01Encounter for general medical examination of adult with abnormal finding Z11.59Encounter for screening for other viral disease O98.41Pregnancy complicated by care of/management affected by viral hepatitis F19.20Other psychoactive substance abuse, uncomplicated Z72.89Other problems related to lifestyle +&41&(3!7,(!T&:2=.(&!U!T&:2=.2:!V&(-2=&3W!'11%3BCCDDD?=93?/,-C9&:2=.(&=,-&(./& :.1.3&C31.12=%./&3C2=:=,:&5,,6;%?.3%X ** effectivecanPriorinfectioncombinationinterferonforeffectivefor hepatitis barriers,rest

rictions, PatientswhohavebeendiagnosedwithHCVshouldbeevaluatedtodeterminethebestSpecialistsgastroenterologists,physicians.often,care for and areallowbecome the main source forpatients with HCV. Forfull list ofFDAapprovedtreatments,pleasevisitps://www.fda.gov/forpatients/illness/hepatitisbc/ucm408658.htm Patientaffordprescriptionof providingationsfreeoffereligibilityhttps://www.nastad.org/sites/default/files/hepatitis Must be 18 years of age ( 12 years of age for Harvoni and Sovaldi)For women of childbearing age, must confirm negative pregnancy test prior to therapyPrescription must be written by or in consultation with an Infectious Disease or GIspecialist (including hepatitis C Project ECHO participants) fibrosis,liver Approval of Treatment for fection: Must be 18 years of ageFor women of childbearing age, must confirm negative pregnancy test prior to therapyPrescription must be written by or in consultation with an nfectious isease gastrointestinal specialistDuration of approval will be up to 24 weeks confirm previously ¥ In the case of previous nintolerancethat Noncomplian

ce will be further reviewed through medical reviewMust have a diagnosis of chronic hepatitis C with �stage 3 fibrosis (regimen approvedwill be dependent on genotype per initial treatment criteria)Must be first request for retreatmentPrescriber and member must provide documentation regarding rationale andmethodology to ensure compliance with therapyPolicies around hepatitis C medication access are continuously changing. For the most up to date information on Indiana Medicaid’s hepatitis C criteria visit the following link and click on “Preferred Drug List” under “Quick Links” https://inmproviderportal.optum.com/providerportal/faces/PreLogin.jsp reimbursedchangereferrefrommanaged Approval of *@ ProjectECHOAccesstohepatitiscarecanbedifficultforpatientslivinginunderservedandruralareas.ojectECHO(ExtensionforCommunityHealthcareOutcomes)istelehealthmodelthatprovidesspecialtyeducationandtrainingfromexpertspecialiststoprimacareclinicians.It allowsphysicians,nursepractitionersanotherclinicianstocareforantreat patientswithHCVothercomplexillnessestheircommunity.Thisprogramoffe

redinIndianathroughtheRichardM.FairbanksSchoolofPublicealthTolearnmoreinformationandtosignuptobecomeparticipant,pleasevisithttps://fsph.iupui.edu/researchcenters/centers/publichealthpractice/ECHO/index.htmlClinicalTrialslinical trialsPatients can find a list of clinical trials in the area where they live after answering a few questionspubliclyvailableClickatients/resources/clinical Viral Hepatitis ImmunizationsHepatitis A and Hepatitis BVaccinesHepatitis A d hepatitisimmunizationrecommended for risk. People infected with hepatitis C should receive hepatitis A and hepatitis B immunizations to prevent coinfection and further liver damage. There is no immunization available for hepatitis C. The Hepatitis A vaccine series is a twodose series, with the second dose administered at least six months after the first. This vaccine is available to anyone ages 12 months and older. The hepatitis B vaccine series is a threedose series with the first dose routinely given at birth. Both the hepatitis A and hepatitis B vaccines are included in the Centers for Disease Control and PreventionÕs rec

ommended childhood immunization schedule so many children will have already received these vaccines. In addition, both the hepatitis A and hepatitis B vaccines are included in the Indiana school immunization requirements. The current Indiana school immunization requirements are available in English and Spanish on the ISDH Immunization Division website. We strongly recommend these vaccines for both children and adults and encourage healthcare providers to check a patientÕs immunization status at every visit.Cost and availabilityThe Indiana Adult Vaccine Program offers vaccines to uninsured and underinsured adults ina number of sites across Indiana, including STD clinis, Federally Qualified Health Centers and local health departments.For more information on immunizations and where you can find Adult Vaccine Providers in your area, please visit the Indiana State Department of HealthÕs mmunization website at https://secure.in.gov/isdh/17094.htm. Viral Hepatitis Immunizations Provider ResourcesA Guide to Comprehensive Hepatitis C Counseling and Testing Recommended Testing Seque

nce for Identifying Current Hepatitis C Virus Infection Interpretation of Results of Test for Hepatitis C Virus Infection and Further Action CenterWatch provides state by state listings of clinical trials for viral hepatitis Hepatitis C Clinical Support Tools University of Washington Hepatitis C Online Hepatitis Web Study (Opportunity for CE Credits) HepCure Live Webinars Tuesdays 4:305:30pm EST(Opportunity of CE Credits) PRIME CME (Opportunities for CE Credits) NASTADÕs Science over Stigma: The Public Health Case against HCV Treatment Sobriety Restrictions Hepatitis C: State of Medicaid Access AASLD/IDSA HCV Guidance: Recommendations forTesting, Managing, and Treating Hepatitis C CDC Viral Hepatitis Serology Training National Viral Hepatitis Action Plan 20172020 National Strategy to Eliminate Hepatitis B and C Indiana State Department of Health Viral Hepatitis Page Patient ResourcesHelp-4-Hep National Hepatitis C Support Line Clinical Trials Find free HIV, STD and Viral Hepatitis Testing and Vaccinations Caring Ambassadors CDC Know More Hepatitis Campaign and Educationa