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LIVER BIOPSY
HS-261
Easy Choice Health Plan, Inc.
Harmony Health Plan of Illinois, Inc.
Missouri Care, Inc.
‘Ohana Health Plan, a plan offered by
WellCare Health Insurance of Arizona, Inc.
WellCare Health Insurance of Illinois, Inc.
WellCare Health Plans of New Jersey, Inc.
WellCare Health Insurance of Arizona, Inc.
WellCare of Florida, Inc.
WellCare of Connecticut, Inc.
WellCare of Georgia, Inc.
WellCare of Kentucky, Inc.
WellCare of Louisiana, Inc.
WellCare of New York, Inc.
WellCare of South Carolina, Inc.
WellCare of Texas, Inc.
Liver Biopsy
Policy Number: HS-261
WellCare Prescription Insurance, Inc.
Windsor Health Plan
Windsor Rx Medicare Prescription Drug Plan
Original Effective Date: 1/8/2015
Revised Date(s): N/A
APPLICATION STATEMENT
The application of the Clinical Coverage Guideline is subject to the benefit determinations set forth by the Centers for Medicare and Medicaid Services (CMS)
National and Local Coverage Determinations and state-specific Medicaid mandates, if any.
Clinical Coverage Guideline
Original Effective Date: 2/5/2015 - Revised: N/A
page 1
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DISCLAIMER
The Clinical Coverage Guideline is intended to supplement certain standard WellCare benefit plans. The terms of a member’s particular Benefit Plan, Evidence of
Coverage, Certificate of Coverage, etc., may differ significantly from this Coverage Position. For example, a member’s benefit plan may contain specific exclusions
related to the topic addressed in this Clinical Coverage Guideline. When a conflict exists between the two documents, the Member’s Benefit Plan always supersedes
the information contained in the Clinical Coverage Guideline. Additionally, Clinical Coverage Guidelines relate exclusively to the administration of health benefit plans
and are NOT recommendations for treatment, nor should they be used as treatment guidelines. The application of the Clinical Coverage Guideline is subject to the
benefit determinations set forth by the Centers for Medicare and Medicaid Services (CMS) National and Local Coverage Determinations and state-specific Medicaid
mandates, if any. Note: The lines of business (LOB) are subject to change without notice; consult www.wellcare.com/Providers/CCGs for list of current LOBs.
BACKGROUND
Liver biopsy is a fundamentally important tool in the management of patients with liver disease, important for
diagnosis as well as staging of liver disease and its use is recommended until clearly superior methodologies are
1
developed and validated (Recommendation Grading: Class IIB, Level C). According to the American Association
for the Study of Liver Diseases (ASSLD), liver biopsy currently has three major roles: (1) for diagnosis, (2) for
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assessment of prognosis (disease staging), and/or (3) to assist in making therapeutic management decisions.
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Percutaneous biopsy is the most common type and involves inserting a hollow needle through the
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abdomen into the liver. This method may be undertaken in one of three ways, namely
palpation/percussion guided, image-guided, and real-time image-guided. A palpation/percussion-guided
transthoracic approach, after infiltration of local anesthesia, is the classic percutaneous method (see also
below). Although the subcostal approach has been performed in patients with hepatomegaly that extends
1
well below the right costal margin, it is not recommended in routine practice without image guidance.
The plugged biopsy is an “add on” technique to a percutaneous liver biopsy and has been proposed as
being potentially safer than a standard percutaneous biopsy among certain patients (i.e., those believed to
be at high risk for bleeding such as those with coagulopathy and/or thrombocytopenia or a small cirrhotic
liver). The plugged biopsy is a modification of the percutaneous method in which the biopsy track is
plugged with collagen or thrombin (or other materials) as the cutting needle is removed from a sheath, while
the breath is still being held. In one study, the approach was both well-tolerated and safe. In another study,
this technique was compared to transjugular liver biopsy among patients with prolonged PT and reduced
platelet counts. The plugged-percutaneous liver biopsy technique was quicker and yielded specimens of
significantly longer length than the transjugular approach, but was complicated by hemorrhage that required
blood transfusion in 2 of 56 (3.5%) of plugged biopsy patients, compared with 0 of 44 (0%) undergoing
transvenous biopsy.
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Transvenous biopsy involves making a small incision in the neck and inserting a needle through a sheath
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through the jugular vein to the liver. A number of situations warrant consideration of this approach.
Patients with clinically demonstrable ascites; a known or suspected hemostatic defect; a small, hard,
cirrhotic liver; morbid obesity with a difficult-to-identify flank site; or those in whom free and wedged hepatic
vein pressure measurements are additionally being sought (see below) should be considered candidates to
undergo liver biopsy by the transvenous route. The technique has been well described in the literature and
should be considered standard. Expense and availability of local expertise are also important variables
1
when considering transvenous biopsy.
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Laparoscopic biopsy involves inserting a laparoscope through a small incision to look inside the body to
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view the surface of organs; a needle is placed through a cannula to remove the liver tissue sample. In
some instances, a surgical or laparoscopic approach is utilized because the liver is noted to be abnormal in
appearance prior to planned surgery or at the time of surgery. Biopsy in this situation is performed either
with typical needle devices or by wedge resection. Notably, the latter has been criticized as producing
overestimates of fibrosis due to its proximity to the capsule. Laparoscopic liver biopsy allows adequate
tissue sampling under direct vision, with direct (and immediate) control of bleeding. It is generally performed
by those with special expertise, typically under general anesthesia. Creation of a pneumoperitoneum (with
nitrous oxide) is highly reliable and allows the use of conscious sedation and performance of the procedure
Clinical Coverage Guideline
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in specialized areas within an endoscopy unit. Most studies that have compared laparoscopic biopsy to
transthoracic percutaneous biopsy have demonstrated greater accuracy in diagnosing cirrhosis with the
former approach; probably because of the added benefit of peritoneal inspection. Complications of this
method include general anesthesia, local abdominal wall or intraperitoneal trauma, and bleeding. Expense
and the requirement for special expertise have limited its use. New laparoscopic techniques may facilitate
laparoscopic liver biopsy, and could theoretically be performed safely at low cost. An exciting possibility is
that techniques extending from natural orifice transluminal endoscopic surgery (NOTES) could be used to
perform liver biopsy. In one study, transgastric flexible endoscopic peritoneoscopy allowed systematic
visualization of the liver with subsequent liver biopsy (and adequate tissue samples for histologic
examination) in a small number of obese patients for whom percutaneous biopsy would have been
1
technically difficult or associated with unacceptably high risk of complication.
Percutaneous liver biopsy may be classified according to the site of entry of the biopsy needle, whether the biopsy
is performed in a blind or guided manner, or whether the biopsy track is plugged after the procedure. Percutaneous
liver biopsy has a small but inherent risk even in the most experienced hands, and it should therefore only be
performed when the benefits of knowing the histology outweigh the risks to the patient (e.g., altering treatment or
defining disease outcome). These benefits should be continually re-evaluated as new treatment options become
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available such as has occurred with the new antiviral therapies in viral hepatitis and in liver transplantation.
Acute hepatitis of unknown etiology, including possible drug related hepatitis, has long been an indication for
percutaneous liver biopsy, but liver biopsy in typical acute viral hepatitis is usually not necessary. The usefulness of
liver biopsy in chronic viral hepatitis was once hotly debated; however, with the advent of new antiviral therapies
there is no doubt of the value of histology in assessing those patients who will benefit from treatment and assessing
their response to it. Patients with chronic hepatitis C virus infection as determined by a positive serum polymerase
chain reaction test, who are being considered (and are otherwise candidates) for antiviral therapy should undergo
liver biopsy. Liver biopsy should probably be undertaken even if the patient has normal aminotransferases as it has
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been reported that up to 50% of patients with active disease have a normal serum alanine aminotransferase.
Radiological Considerations
Sonography is often the first imaging procedure performed in the evaluation of individuals with suspected liver
disease. Evaluation for biliary dilatation is always performed, because bile duct obstruction can cause abnormal
liver test results, raising the suspicion of liver disease. Ultrasound is a useful but imperfect tool in evaluating diffuse
liver disease. Sonography can show hepatomegaly, fatty infiltration of the liver, and cirrhosis, all with good but
imperfect sensitivity and specificity. Sonography is of limited usefulness in acute hepatitis. Increased parenchymal
echogenicity is a reliable criterion for diagnosing fatty liver. Cirrhosis can be diagnosed in the correct clinical setting
when the following are present: a nodular liver surface, decreased right lobe–caudate lobe ratio, and indirect
evidence of portal hypertension (collateral vessels and splenomegaly). Ultrasound plays an important role in the
imaging of conditions and procedures common in patients with diffuse liver disease. The most common
sonographic finding in hepatitis is probably hepatomegaly. The so-called “starry night liver” pattern, increased
4,9
periportal echoes coupled with decreased parenchymal echogenicity, is not useful clinically.
Ultrasound guided percutaneous liver biopsy is used extensively in the investigation of focal liver lesions; however,
its use in diffuse liver disease is more controversial. It has been postulated that ultrasound guided biopsy should
reduce complications. As the commonest cause of mortality is bleeding, it follows that the incidence of bleeding
should be proportional to the incidence of hematoma formation. The rate of hematoma formation however is
unaffected by the use of ultrasound guidance. The use of ultrasound to assist in liver biopsy for non-focal disease
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has been estimated to be cost effective in the U.S. if the additional cost of ultrasound is less than US$102.
The American College of Radiology (ACR), Society of Interventional Radiology (SIR), and Society for Pediatric
Radiology (SPR) issued a joint guideline stating that the use of guided liver biopsy or fine needle aspiration in the
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diagnosis of hepatic tumors is the safest way of managing patients with liver disease.
Clinical Coverage Guideline
Original Effective Date: 2/5/2015 - Revised: N/A
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Image-guided liver biopsy is recommended in certain clinical situations including in patients with known intrahepatic
lesions (real-time imaging is strongly preferred) and in those with previous intra-abdominal surgery who may have
adhesions. Image guided liver biopsy should also be considered in the following situations: patients with small livers
1
that are difficult to percuss, obese patients, and patients with clinically evident ascites (Class I, Level C).
American Association for the Study of Liver Diseases
1
Highlights from the AASLD recommendations reflect guidelines that are intended to be flexible, in contrast to
standards of care, which are inflexible policies to be followed in every case. Specific recommendations are based
on relevant published information. Recommendation highlights include:
Focal Disease and Mass Lesions
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Liver biopsy should be considered in patients in whom diagnosis is in question, and when knowledge of a
specific diagnosis is likely to alter the management plan (Class I, Level B).
Liver histology is an important adjunct in the management of patients with known liver disease, particularly
in situations where (prognostic) information about fibrosis stage may guide subsequent treatment; the
decision to perform liver biopsy in these situations should be closely tied to consideration of the risks and
benefits of the procedure (Class I, Level B).
Complications
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Those performing liver biopsy must be cognizant of multiple potential complications (including death) that
may occur after liver biopsy and discuss these appropriately with their patients beforehand (Class I, Level C).
Platelet transfusion should be considered when levels are less than 50,000-60,000/mL (this applies
whether one is attempting biopsy transcutaneously or transvenously) (Class I, Level C).
Use of prophylactic or rescue strategies (e.g., plasma, fibrinolysis inhibitors, recombinant factors) should be
considered in specific situations, although their effectiveness remains to be established (Class IIa, Level C).
In patients with renal failure or on hemodialysis, desmopressin (DDAVP) may be considered, although its
use appears to be unnecessary in patients on stable dialysis regimens (Class IIa, Level B).
Patients on chronic hemodialysis should be well dialyzed prior to liver biopsy, and heparin should be
avoided if at all possible (Class I, Level C).
Pathological Considerations
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Because diagnosis, grading, and staging of non-neoplastic, diffuse parenchymal liver disease is dependent
on an adequate sized biopsy, a biopsy of at least 2-3 cm in length and 16-gauge in caliber is recommended
(Class I, Level C).
It is recommended that if applicable, the presence of fewer than 11 complete portal tracts be noted in the
pathology report, with recognition that diagnosis, grading, and staging may be incorrect due to an
insufficient sample size (Class I, Level C).
If cirrhosis is suspected, a cutting rather than a suction needle is recommended (Class I, Level B).
In clinical practice, use of a simple (e.g., Metavir or Batts-Ludwig) rather than complex (e.g., Ishak) scoring
system is recommended (Class I, Level C).
Liver biopsy is currently a fundamentally important tool in the management of patients with liver disease,
important for diagnosis as well as staging of liver disease and its use is recommended until clearly superior
methodologies are developed and validated (Class IIB, Level C).
Pre-Biopsy
The AASLD recommends the following as part of the pre-biopsy testing:

1
Prior to performance of liver biopsy, patients should be educated about their liver disease and about
Clinical Coverage Guideline
Original Effective Date: 2/5/2015 - Revised: N/A
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investigations other than liver biopsy (if any) that may also provide diagnostic and prognostic information
(Class I, Level C).
Prior to performance of liver biopsy, patients must be carefully informed about the procedure itself including
alternatives (as above), risks, benefits, and limitations; written informed consent should be obtained (Class
I, Level C).
Providers should consider the following medication recommendations:
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1
Antiplatelet medications should be discontinued several to 10 days before liver biopsy, although there is
uncertainty surrounding the need for their discontinuation. Management of specific compounds should be
handled on a case-by-case basis, taking into account their clinical indications, as well as the potential
bleeding risk associated with their use in the setting of liver biopsy (Class I, Level C).
Anticoagulant medications should be discontinued prior to liver biopsy. Warfarin should generally be
discontinued at least 5 days prior to liver biopsy. Heparin and related products should be discontinued 1224 hours prior to biopsy. In all patients, the risk of discontinuing anticoagulant medications must be weighed
against the (potential) risk of bleeding during/after liver biopsy (Class I, Level C).
Antiplatelet therapy may be restarted 48-72 hours after liver biopsy (Class I, Level C).
Warfarin may be restarted the day following liver biopsy (Class I, Level C).
Grading System for Recommendations
Classification
Class I
Class II
Class IIa
Class IIb
Class III
Conditions for which there is evidence and/or general agreement that a given diagnostic evaluation, procedure or treatment is
beneficial, useful, and effective
Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a diagnostic
evaluation, procedure, or treatment
Weight of evidence/opinion is in favor of usefulness/efficacy
Usefulness/efficacy is less well established by evidence/opinion
Conditions for which there is evidence and/or general agreement that a diagnostic evaluation/procedure/treatment is not
useful/effective and in some cases may be harmful
Level of Evidence
Level A
Data derived from multiple randomized clinical trials or meta-analyses
Level B
Data derived from a single randomized trial, or nonrandomized studies
Level C
Only consensus opinion of experts, case studies, or standard-of-care
POSITION STATEMENT
Applicable To:
Medicaid
Medicare
Liver biopsy is considered medically necessary when diagnosing and treating liver disease. The member must
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meet at least one of the following:
1. Percutaneous Liver Biopsy
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Percutaneous liver biopsy is considered medically necessary for any of the following:
 Evaluation of abnormal liver test results, if all other workup is unrevealing
 Confirmation of diagnosis and prognostication
 Determination of stage of fibrosis and grade of inflammation for chronic hepatitis B and hepatitis C
 Evaluation of autoimmune hepatitis
 Evaluation of a liver mass that does not exhibit typical imaging features of hepatocellular carcinoma
(HCC)
Clinical Coverage Guideline
Original Effective Date: 2/5/2015 - Revised: N/A
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Quantitative estimation of iron in hemochromatosis
Quantitative estimation of copper in Wilson disease
Estimation of the severity of alcoholic liver disease
Evaluation of suspected drug toxicity or drug reactions
Evaluation of the suitability of a donor liver for transplantation
Diagnosis and staging of nonalcoholic fatty liver disease (NAFLD) / nonalcoholic steatohepatitis (NASH)
Evaluation of unexplained jaundice
Diagnosis of cholestatic liver disease
Evaluation of infiltrative or granulomatous disorders
Evaluation of liver injury from immunosuppressive agents (methotrexate)
Follow-up evaluation while on antiviral treatment for chronic hepatitis C (rare)
Monitoring of disease activity of autoimmune hepatitis during treatment (may assist in determining if
therapy can be discontinued)
Following a case of liver transplantation to evaluate and manage rejection
Diagnosis of acute cellular rejection
Diagnosis of chronic rejection
Diagnosis of recurrent hepatitis C
Diagnosis of post-transplant lymphoproliferative disorder
Diagnosis of cytomegalovirus (CMV) hepatitis
Protocol biopsies to monitor for fibrosis or inflammation (particularly in patients who received liver
transplants to treat liver failure in chronic hepatitis C)
5,6
Contraindications of percutaneous liver biopsy include:
 Uncooperative patient
 Inability to identify a suitable biopsy site by either percussion or ultrasonographic guidance
 Prolonged (>1.5) international normalized ratio (INR)
 Decreased platelet count (< 60,000/mm3) (thrombocytopenia)
 Bleeding diathesis (e.g., hemophilia)
 Recent use (within the last 7 days) of aspirin or nonsteroidal anti-inflammatory drugs (NSAID) or
antiplatelet class of medications
 Unavailability of blood products for transfusion
 Difficult body habitus of patient (transjugular route preferred), including morbid obesity of patient
 Ascites
 No backup support available from surgery or interventional radiology in case of a complication
 Suspected hemangioma or hepatic echinococcal cysts
 Abdominal wall infection over the identified biopsy site
 Infection in the right pleural cavity or below the right hemidiaphragm
 Bowel overlying biopsy site (on ultrasound or other abdominal imaging)
Plugged liver biopsy is considered medically necessary as an alternative method to a transvenous approach
for members with prolonged PT and reduced platelet counts.
Computed Tomography (CT) needle biopsy of the liver is considered medically necessary when there is
inadequate visualization of a target lesion by ultrasound. Image-guided liver biopsy is recommended in certain
clinical situations including in patients with known intrahepatic lesions (real-time imaging is strongly preferred)
and in those with previous intra-abdominal surgery who may have adhesions. Image guided liver biopsy should
also be considered in the following situations: patients with small livers that are difficult to percuss, obese
1
patients, and patients with clinically evident ascites (Class I, Level C).
Clinical Coverage Guideline
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2. Transvenous (Transjugular or Transfemoral)
Transjugular liver biopsy is considered medically necessary for members with diffuse liver disease and
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meet one or more of the following:
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Deranged coagulation; OR,
Massive ascites; OR,
Liver abnormalities such as peliosis hepatitis; OR,
In combination with transjugular intrahepatic portosystemic shunt (TIPSS) or venography; OR,
Any other contraindication for percutaneous biopsy; OR,
Failed percutaneous biopsy; OR,
Morbid obesity
Contraindications of transvenous liver biopsy include:
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
7
When no specific contraindications exist, but attempts should be made to correct coagulation
derangements before proceeding.
Lack of venous access is a limitation for this procedure.
Note that this technique should not be used in assessing focal liver lesions.
3. Laparoscopic or Open Surgical
Laparoscopic (or open surgical) liver biopsy is considered medically necessary for members needing a
liver biopsy that are already undergoing Laparoscopy or open Laparotomy for a separate but medically
necessary reason.
Place of Service
Outpatient. The following guidelines reflect the American Gastroenterological Association’s position statement on
6, 8
outpatient percutaneous liver biopsy.
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The patient must be able to easily return to the hospital where the procedure was performed within 30
minutes of developing any adverse symptoms.
A reliable individual must be available to stay with the patient during the first night after the liver biopsy and
provide care and transportation to the hospital, if necessary.
The patient should not have any preexisting serious medical problems that might increase the risk of
complications from the biopsy. Such problems may include encephalopathy, ascites, liver failure with
severe jaundice, significant extrahepatic obstruction, significant coagulopathies, or serious comorbidities
such as severe congestive heart failure. Also, patients should not be very old, very young, or so anxious
that they require sedation.
The facility where the biopsy is to be performed should have an approved laboratory, blood banking unit,
easy access to an inpatient bed, and personnel to monitor the patient for 6 hours after the biopsy.
Inpatient. The patient should be hospitalized after biopsy if any evidence exists of bleeding, bile leak,
pneumothorax, or other organ puncture. Hospitalization is suggested if the patient’s pain requires more than 1 dose
of an analgesic in the first 4 hours after the biopsy.
Discharge. Post liver biopsy observation should continue for six hours and if at the end of this period there have
been no complications then the Member may be discharged. The Member should, however, have a responsible
person to stay with on the first post-biopsy night and should be able to return to hospital within 30 minutes should
3
the need arise.
Clinical Coverage Guideline
Original Effective Date: 2/5/2015 - Revised: N/A
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CODING
CPT Codes
47000
Percutaneous needle biopsy of liver
47001
Percutaneous needle biopsy of liver, when done for indicated purpose at time of other major procedure
(list separately in addition to code for primary procedure)
HCPCS Codes – No applicable codes.
Covered ICD-9 Codes
070.32
Chronic hepatitis type B
070.54
Chronic hepatitis type C
078.5 (573.1) Cytomegalic inclusion virus
238.77
PTLD (post-transplant lymphoproliferative disorder
275.03
Hemochromatosis
275.1
Wilson’s Disease
571.3
Alcoholic liver disease NEC
571.1
Alcoholic liver disease acute
571.2
Alcoholic liver disease chronic
571.42
Autoimmune hepatitis
571.49
Recurrent Hepatitis
571.5
Cirrhosis of Liver
571.8
Nonalcoholic fatty liver disease
782.4
Jaundice
790.6
Abnormal liver function test
996.82
Rejection liver transplant
Covered ICD-10 Codes
B18.1
Chronic viral hepatitis B without delta-agent
B18.2
Chronic viral hepatitis C
B25.0
Cytomegaloviral pneumonitis
B25.1
Cytomegaloviral hepatitis
B25.2
Cytomegaloviral pancreatitis
B25.8
Other cytomegaloviral diseases
B25.9
Cytomegaloviral disease, unspecified
D47.Z1
Post-transplant lymphoproliferative disorder (PTLD)
E79.0
Hyperuricemia without signs of inflammatory arthritis and tophaceous disease
E83.118
Other hemochromatosis
E83.119
Hemochromatosis, unspecified
E83.00
Disorder of copper metabolism, unspecified
E83.01
Wilson s disease
E83.09
Other disorders of copper metabolism
K70.10
Alcoholic hepatitis without ascites
K70.11
Alcoholic hepatitis with ascites
K70.2
Alcoholic fibrosis and sclerosis of liver
K70.30
Alcoholic cirrhosis of liver without ascites
K70.31
Alcoholic cirrhosis of liver with ascites
K70.40
Alcoholic hepatic failure without coma
K70.41
Alcoholic hepatic failure with coma
K70.9
Alcoholic liver disease, unspecified
K73.1
Chronic lobular hepatitis, not elsewhere classified
K73.2
Chronic active hepatitis, not elsewhere classified
K73.8
Other chronic hepatitis, not elsewhere classified
Clinical Coverage Guideline
Original Effective Date: 2/5/2015 - Revised: N/A
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K74.0
K74.60
K74.69
K75.4
K75.81
K76.0
K76.89
K77
R17
R78.71
R78.79
R78.89
R79.0
R79.89
R79.9
Hepatic fibrosis
Unspecified cirrhosis of liver
Other cirrhosis of liver
Autoimmune hepatitis
Nonalcoholic steatohepatitis (NASH)
Fatty (change of) liver, not elsewhere classified
Other specified diseases of liver
Liver disorders in diseases classified elsewhere
Unspecified jaundice
Abnormal lead level in blood
Finding of abnormal level of heavy metals in blood
Finding of other specified substances, not normally found in blood
Abnormal level of blood mineral
Other specified abnormal findings of blood chemistry
Abnormal finding of blood chemistry, unspecified
*Current Procedural Terminology (CPT®) 2015 American Medical Association: Chicago, IL.
REFERENCES
1.
2.
3.
4.
5.
6.
7.
8.
9.
Rockey, DC, Caldwell, SH, Goodman, ZD, Nelson, RC, Smith, AD. American Association for the Study of Liver Diseases position paper:
liver biopsy. https://www.aasld.org/practiceguidelines/ Documents/Bookmarked%20Practice%20Guidelines/Liver%20Biopsy.pdf. 1999.
Accessed July 10, 2014.
Liver biopsy. National Digestive Diseases Information Clearinghouse (NDDIC) Web site.
http://digestive.niddk.nih.gov/ddiseases/pubs/liverbiopsy/. Published Accessed August 12, 2014.
Grant A, Neuberger J. Guidelines on the use of liver biopsy in clinical practice. Gut. 1999;45(Suppl IV):IV1–IV11.
http://gut.bmj.com/content/45/suppl_4/IV1.full.pdf+html. Accessed July 10, 2014.
American College of Radiology. ACR (American College of Radiology), SIR (Society of Interventional Radiology, and SPR (Society for
Pediatric Radiology) practice guideline for the performance of image-guided percutaneous needle biopsy (PNB).
http://www.acr.org/~/media/1D9E3F3270CF44F8A2E994C94F2F0FAC.pdf. Published 2013. Accessed July 10, 2014.
Diagnostic liver biopsy. MedScape Web site. http://emedicine.medscape.com/article/1819437-overview#a15. Published October 7, 2013.
Accessed August 13, 2014.
Percutaneous liver biopsy. MedScape Web site. http://emedicine.medscape.com/article/149684-overview#a03. Published November 18,
2013. Accessed August 12, 2014.
Transjugular liver biopsy. MedScape Website. http://emedicine.medscape.com/article/1423263-overview. Published January 15, 2014.
Accessed August 12, 2014.
Jacobs, WH, Goldberg SB. Statement on outpatient percutaneous liver biopsy. Digestive Diseases and Sciences. 1989;34(3):322-323.
Tchelepi, H, Ralls, PW, Radin, R, Grant, E. Sonography of diffuse liver disease. J Ultrasound Med. 2002; 21(9):1023-1032.
MEDICAL POLICY COMMITTEE HISTORY AND REVISIONS
Date
Action
2/5/2015

Approved by MPC. New.
Clinical Coverage Guideline
Original Effective Date: 2/5/2015 - Revised: N/A
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