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Pay attention to whether the cirrhosis is specified and whether complications are present.

Struggling to navigate the tangled web of cirrhosis coding? You’re not alone. With multiple etiologies, complications, and severity levels to consider, assigning the right ICD‑10-CM code can feel like solving a puzzle.

Read this guide to cut through the confusion, and learn exactly how to capture cirrhosis — and its complications — accurately and efficiently.

1. What Is Cirrhosis?

Cirrhosis is the end‑stage of chronic liver injury and scarring (fibrosis) that alters liver structure and function. The disease is often caused by conditions like chronic alcohol use, viral hepatitis, nonalcoholic fatty liver disease, or toxic liver injury.

Clinically, cirrhosis may be compensated (liver function relatively preserved) or decompensated when complications develop — such as ascites (fluid in the abdomen), variceal bleeding, hepatic encephalopathy, or portal hypertension.

As a coder, you must pay close attention to whether the cirrhosis is specified (for example, alcoholic, toxic, biliary) and whether complications are present. Those details drive code selection and greatly affect clinical severity, reimbursement, and risk adjustment.

2. Identify Key ICD‑10‑CM Code Families for Cirrhosis

Here are the main ICD‑10‑CM categories for cirrhosis and the specific codes you need to know:

• K74.- (Fibrosis and cirrhosis of liver) 
• K70.3- (Alcoholic cirrhosis of liver) if alcohol is the cause of the cirrhosis
• K71.7 (Toxic liver disease with fibrosis and cirrhosis of liver) for cirrhosis due to toxins or drugs 
• K74.5 (Biliary cirrhosis, unspecified), of cholestatic or biliary origin
• K74.60 (Unspecified cirrhosis of liver)
• K74.69 (Other cirrhosis of liver) for cryptogenic, portal, postnecrotic, macronodular, micronodular, or mixed types of cirrhosis

3. Understand Compensated vs. Decompensated Cirrhosis

An important distinction in cirrhosis coding is whether the disease is decompensated. Decompensated refers to cirrhosis that is complicated by significant clinical manifestations, as opposed to compensated cirrhosis, where the liver is scarred but it is still functioning well and the patient may have few or no symptoms.

But does that affect your coding? While “decompensated cirrhosis” is a clinical concept (meaning cirrhosis with complications like ascites, variceal bleeding, or encephalopathy), ICD-10-CM does not provide a single “decompensated cirrhosis” code under the K74.- category.

Instead, you should still:

• Assign the correct K74.- code based on the type or etiology (for example, unspecified, others).
• Report each documented complication separately (for example, ascites, varices, encephalopathy) with additional codes.

4. Code Common Complications of Cirrhosis

When cirrhosis is documented with complications, you should also check for specific codes for the complications, because they often matter clinically and for reimbursement. Here are some of the codes you might use for complications:

• Ascites: You can report R18.8 (Other ascites), when present, in addition to cirrhosis.
• Esophageal varices: Use the I85.- (Esophageal varices) series for varices, including bleeding or non-bleeding varices in cirrhotic patients.
• Hepatic encephalopathy/liver failure: You may need to look at K72.- (Hepatic failure, not elsewhere classified) or other relevant liver failure codes, depending on documentation.

5. Know Why Etiology Matters for Coding

Knowing the etiology (cause) of cirrhosis (alcohol, viral, toxic, etc.) allows you to choose a more specific ICD‑10-CM code, which improves coding quality and can affect risk adjustment. For instance, alcoholic cirrhosis means looking to K70.3- (or subcodes), while toxic cirrhosis means reporting K71.7.

If the cause is not documented, you may have to use an unspecified or “other” cirrhosis code, but you should consider querying the provider when possible to improve specificity.

6. Review These Documentation Tips

To code cirrhosis accurately, make sure the medical record includes:

• Diagnosis confirmation: Is there imaging (ultrasound, CT), biopsy, or clinical documentation of cirrhosis?
• Etiology: Does the physician document why the patient has cirrhosis (for example, alcohol use, virus)?
• Complications: Check for ascites, variceal bleeding, encephalopathy, and portal hypertension, and record them separately.
• Severity: Is the cirrhosis stable (compensated) or decompensated?
• Relevant labs and scores: If documented, the patient’s model for end-stage liver disease (MELD) score or Child‑Pugh classification can support clinical severity.

If documentation is vague — for example, “liver cirrhosis” without cause or complications — you should query the provider for specificity (etiology, decompensation, associated conditions).

7. Learn How to Avoid Common Pitfalls

With liver cirrhosis being a complex condition, it’s easy to make mistakes. Look at the following common pitfalls:

• Using nonbillable root codes: Don’t stop at K74.-, because that’s nonbillable. Use the most specific four‑ or five‑character code (for example, K74.60, K74.69).
• Missing the cirrhosis cause: If the etiology isn’t documented, you might undercode severity or miss an opportunity for more accurate coding.
• Overlooking complications: You must capture ascites, varices, or encephalopathy if present. They significantly change the clinical picture.
• Ignoring decompensation: Decompensated cirrhosis (for example, with ascites) should be coded to reflect that severity (for example, K74.61) when documented.

8. Know Why Accurate Cirrhosis Coding Matters

Proper coding of cirrhosis and its complications helps ensure correct payment, especially in value-based care models. Cirrhosis is often tracked for mortality, transplant referral, and readmission risk. Accurate codes support quality reporting.

Also, documenting severity (compensated versus decompensated) can influence clinical decisions, referrals, and monitoring.

9. Take Advantage of This Quick Reference Table

Use this quick reference table to help you choose the best ICD-10-CM code:

Takeaway

In conclusion, always aim for specificity when coding cirrhosis. Capture both the underlying cause and any documented complications. Don’t hesitate to query your provider if the documentation is unclear. Assign additional codes for complications such as ascites, varices, or hepatic encephalopathy to fully reflect the patient’s condition.

Accurate cirrhosis coding goes beyond completing a chart; it supports risk-adjusted care, quality reporting, and proper reimbursement. By following these best practices, you ensure that every case is coded efficiently, accurately, and in full compliance, truly reflecting the patient’s clinical complexity.

Suzanne Burmeister, BA, MPhil, Medical Writer and Editor