ICD-10 Coding for Abnormal Liver Function(R94.5, R74.01)
Complete ICD-10-CM coding and documentation guide for Abnormal Liver Function. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Abnormal Liver Function
R94.5Primary Range
Abnormal results of liver function studies
Used for unexplained abnormalities in liver function tests without a definitive diagnosis.
Abnormal serum enzyme levels
Includes codes for specific enzyme elevations such as transaminases.
Diseases of liver
Used when a specific liver disease is diagnosed, such as cirrhosis or hepatitis.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R94.5 | Abnormal results of liver function studies | Use when liver function tests are abnormal but no specific liver disease is diagnosed. |
|
| R74.01 | Elevated transaminases | Use when ALT/AST are elevated without other enzyme abnormalities. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for abnormal liver function
Essential facts and insights about Abnormal Liver Function
Primary ICD-10-CM Codes for abnormal liver function
Decision Criteria
clinical Criteria
- ALT/AST/ALP >2x ULN without a specific diagnosis
documentation Criteria
- Provider must document 'abnormal liver function studies'
Applicable To
- Unexplained abnormal liver function tests
Excludes
- Specific liver diseases (K70-K77)
Clinical Validation Requirements
- ALT/AST/ALP >2x ULN without confirmed diagnosis
- Provider documentation of 'abnormal liver function studies'
Code-Specific Risks
- Using R94.5 when a definitive diagnosis exists
Coding Notes
- Ensure provider documentation explicitly states the abnormality.
R74.01 - Elevated transaminases
Use when ALT/AST are elevated without other enzyme abnormalities.
Applicable To
- Isolated ALT/AST elevation
Excludes
- Cholestasis (K83.1)
Clinical Validation Requirements
- Documented elevation of ALT/AST without cholestasis
Coding Notes
Ensure specific enzyme elevations are documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Unspecified abdominal pain
R10.9Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Abnormal Liver Function to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R94.5.
Impact
Clinical: Misrepresentation of patient condition., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Require explicit provider documentation., Educate providers on documentation standards.
Impact
Reimbursement: May lead to lower DRG assignment., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use the specific disease code (e.g., K74.60 for cirrhosis).
Impact
Using R94.5 when a specific liver disease is diagnosed.
Mitigation Strategy
Educate coders on proper code selection.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Abnormal Liver Function, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Abnormal Liver Function
Use these documentation templates to ensure complete and accurate documentation for Abnormal Liver Function. These templates include all required elements for proper coding and billing.
Gastroenterology Consult for Abnormal LFTs
Specialty: GastroenterologyRequired Elements
- Patient history
- Specific lab values
- Imaging results
- Provider's clinical assessment
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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