Cirrhosis coding can feel complicated, especially when a single missing detail, like whether the cirrhosis is alcoholic, non-alcoholic, or associated with other hepatic conditions, can completely change which ICD-10 code applies. Unlike general liver disease codes, cirrhosis diagnoses must be supported by clear clinical findings, imaging interpretation, and laboratory evidence to meet payer medical-necessity requirements. According to CMS, K74-series liver fibrosis and cirrhosis codes often trigger enhanced scrutiny because they are frequently linked to high-cost services such as CT scans, abdominal ultrasounds, paracentesis, and prolonged E/M encounters.
The American Health Information Management Association (AHIMA) stresses that incorrect cirrhosis coding — especially misuse of unspecified code K74.60 when etiology is documented, remains one of the top drivers of chronic-care denials. Meanwhile, the Office of Inspector General (OIG) consistently highlights liver-disease claims among high-risk categories due to their association with complications such as portal hypertension, ascites, and hepatic failure, all of which require precise code selection and documentation of clinical severity. The CDC and HHS further emphasize that cirrhosis represents a progressive and often irreversible hepatic condition, making accurate diagnosis coding essential for continuity of care, population tracking, and reimbursement integrity.
For billing teams, mastering the ICD-10 Code for Cirrhosis of Liver (K74.60) means understanding not only the clinical presentation but also the compliance standards that govern chronic liver disease documentation. PROMBS’ compliance-driven workflow integrates CMS, AHIMA, and OIG guidelines to ensure every cirrhosis claim is specific, audit-defensible, and correctly linked to the supporting CPT procedures that justify medical necessity.
Did You Know?
The OIG found that nearly $300 million in annual overpayments stemmed from miscoded or insufficiently documented liver-disease claims. PROMBS’ proactive denial-prevention system audits each cirrhosis claim at the point of coding, guaranteeing that K74.60 submissions meet all CMS medical-necessity and documentation-completeness standards before transmission.
Key Takeaway: Correctly assigning K74.60 for cirrhosis of the liver is not only about clinical accuracy, it directly determines whether payers recognize the severity and medical necessity of services like imaging, lab monitoring, and long-term management. According to HFMA, accurate chronic-disease coding can improve clean-claim approval rates by over 30%, reduce audit exposure, and prevent downstream denials tied to insufficient documentation. PROMBS ensures every cirrhosis claim aligns with CMS, AHIMA, and OIG compliance standards prior to submission.
What is cirrhosis of liver and what are its symptoms?
Cirrhosis of the liver is a chronic, progressive, and irreversible hepatic disorder characterized by fibrosis, nodular regeneration, and architectural distortion of the liver parenchyma. Over time, it impairs blood flow and reduces liver function, leading to portal hypertension, hepatic encephalopathy, and in severe cases, liver failure. Clinically, cirrhosis develops from repeated hepatic injury caused by conditions such as chronic alcohol use, viral hepatitis (B or C), or non-alcoholic steatohepatitis (NASH). According to the Centers for Medicare & Medicaid Services (CMS), cirrhosis represents one of the most resource-intensive chronic diseases due to its link with multi-organ complications. The American Health Information Management Association (AHIMA) notes that documentation must clearly state whether cirrhosis is alcoholic, post-necrotic, biliary, or unspecified to assign the most specific ICD-10 code possible. When etiology isn’t documented, coders use K74.60-Unspecified Cirrhosis of Liver, which serves as the default ICD-10 Code for Cirrhosis of Liver.
From a billing standpoint, correct documentation of ascites, variceal bleeding, hepatic encephalopathy, or jaundice ensures that the diagnosis supports medical necessity for related CPT procedures such as diagnostic paracentesis (49082), abdominal ultrasound (76705), or hepatic panel testing (80076). The Office of Inspector General (OIG) has repeatedly cited missing linkage between cirrhosis and complications as a common compliance error in gastroenterology billing audits. PROMBS’ pre-bill compliance review automatically detects such omissions and prompts for correction before submission.
| Symptom / Indicator | Clinical Description | Compliance Insight |
|---|---|---|
| Fatigue and weakness | Reduced hepatic detoxification leads to systemic fatigue and malaise. | CMS advises linking symptom documentation to liver-function testing results for claim validity. |
| Jaundice | Yellowing of the skin and eyes caused by bilirubin buildup. | AHIMA stresses that jaundice must be explicitly described in progress notes for accurate ICD-10 capture. |
| Ascites | Abdominal fluid accumulation due to portal hypertension. | HFMA recommends correlating imaging and paracentesis CPT codes with cirrhosis diagnosis. |
| Spider angiomas | Vascular lesions due to hormonal imbalance in liver disease. | HHS highlights their importance in clinical differentiation of advanced hepatic pathology. |
| Hepatic encephalopathy | Confusion, tremors, or altered mental state from ammonia accumulation. | OIG lists missing cognitive findings as a top compliance deficiency in hepatic claims. |
Each symptom plays a crucial role in demonstrating medical necessity for diagnostic testing and therapeutic procedures. Coders must ensure that these findings appear in both the clinical note and claim narrative. PROMBS’ AI-driven documentation validator verifies that symptom narratives align with the ICD-10 description of K74.60 and related CPT codes before submission.
Did You Know?
The HFMA reported that cirrhosis-related claims with incomplete symptom documentation have a 23 % higher denial rate. PROMBS’ integrated RCM engine links lab data, imaging reports, and clinical findings directly within the EHR, ensuring every ICD-10 Code for Cirrhosis of Liver claim passes compliance validation with CMS and OIG standards.
What is the ICD-10 code for cirrhosis of liver and what does it mean?
The official ICD-10 Code for Cirrhosis of Liver is K74.60-Unspecified Cirrhosis of Liver, as defined by the Centers for Medicare & Medicaid Services (CMS). It represents a chronic, irreversible liver condition marked by fibrosis and nodule formation when the provider does not specify the underlying cause such as alcohol, hepatitis, or biliary obstruction. The American Health Information Management Association (AHIMA) clarifies that K74.60 should be used only when the documentation confirms cirrhosis but omits etiology or classification. Cirrhosis codes fall within ICD-10-CM Chapter 11-Diseases of the Digestive System (K00–K95), a section covering hepatic, gastrointestinal, and biliary disorders. Proper selection of the subtype code improves diagnostic precision and compliance reporting, especially for HCC risk adjustment. PROMBS ensures that every cirrhosis claim includes the appropriate level of specificity, validating each entry against the provider’s documentation, imaging results, and laboratory data before submission to maintain CMS accuracy and OIG audit readiness.
| ICD-10 Code | Description | Documentation Context |
|---|---|---|
| K70.30 | Alcoholic cirrhosis of liver without ascites | Used when documentation confirms alcohol-related etiology per AHIMA and CMS guidance. |
| K70.31 | Alcoholic cirrhosis of liver with ascites | Assigned when imaging or exam notes show fluid accumulation consistent with HHS criteria. |
| K74.3 | Primary biliary cirrhosis | Appropriate for autoimmune etiology validated through lab or biopsy per OIG clinical integrity review. |
| K74.4 | Secondary biliary cirrhosis | Used when biliary obstruction causes hepatic fibrosis as described by HFMA billing policy. |
| K74.60 | Unspecified cirrhosis of liver | Default code for documented cirrhosis without identified cause, recognized by CMS as compliant when no etiology is stated. |
Accurate assignment of K74.60 requires detailed provider notes describing hepatic fibrosis, laboratory confirmation (elevated bilirubin, low albumin, prolonged INR), and any relevant imaging findings. If the cause becomes known later, coders should update the claim to the appropriate specific code (for example, K70.31 for alcoholic cirrhosis with ascites). PROMBS’ real-time coding validator reviews every liver-disease claim to ensure such specificity updates occur automatically, protecting against overpayment recovery actions and compliance penalties.
Did You Know?
The Office of Inspector General (OIG) found that 14 % of cirrhosis-related claims lacked proper documentation of etiology or ascites status. PROMBS prevents this through its integrated audit engine, which verifies that every ICD-10 Code for Cirrhosis of Liver submission matches the provider’s diagnostic narrative, imaging evidence, and laboratory findings before the claim reaches the payer.
Which ICD-10 chapter includes the ICD-10 code for cirrhosis of liver?
The ICD-10 Code for Cirrhosis of Liver (K74.60) is categorized under ICD-10-CM Chapter 11- Diseases of the Digestive System (K00–K95), as defined by the Centers for Medicare & Medicaid Services (CMS). This chapter includes disorders of the gastrointestinal tract, liver, gallbladder, pancreas, and associated digestive organs. The American Health Information Management Association (AHIMA) instructs coders to confirm that cirrhosis codes are assigned only when liver pathology is clearly documented, and that other digestive-system conditions, such as viral hepatitis or cholestasis, are separately coded when clinically supported. The Healthcare Financial Management Association (HFMA) highlights that digestive system coding accuracy significantly impacts risk-adjusted reimbursement because liver diseases often carry high HCC weights under value-based payment models. PROMBS incorporates this chapter mapping into its automated compliance workflow to ensure that all liver-related claims are correctly sequenced and classified under the appropriate ICD-10 chapter for CMS acceptance and OIG audit protection.
| ICD-10 Chapter | Code Range | Category Description | Compliance Insight |
|---|---|---|---|
| Chapter 11 | K00–K95 | Diseases of the Digestive System | Includes cirrhosis, hepatitis, pancreatitis, and biliary disorders, per CMS. AHIMA recommends verifying that all cirrhosis codes include documented etiology or are properly designated as unspecified (K74.60). |
| Chapter 1 | A00–B99 | Certain infectious and parasitic diseases | Includes viral hepatitis (B15–B19) that may cause cirrhosis, per HHS. Used when cirrhosis is secondary to hepatitis infection and requires dual coding. |
| Chapter 5 | F01–F99 | Mental and behavioral disorders | Includes alcohol dependence (F10.20) when cirrhosis is alcohol-induced, per OIG. Ensure linkage between alcohol-related disorder and cirrhosis code to justify K70.30 or K70.31. |
| Chapter 18 | R00–R99 | Symptoms and abnormal findings | Includes abnormal liver function results before definitive diagnosis, per HFMA. Use temporarily before EHR confirmation of cirrhosis. |
Accurate ICD-10 chapter classification plays a key role in both compliance and reimbursement accuracy. When providers fail to document underlying causes like hepatitis or alcohol use, coders may default to K74.60, which can reduce reimbursement accuracy and risk-adjustment scoring. PROMBS’ chapter-mapping intelligence automatically cross-checks the diagnosis context lab results, patient history, and imaging findings to confirm whether the condition belongs under Chapter 11 or should include secondary chapter linkages (e.g., Chapter 1 for hepatitis-related cases).
Did You Know?
The OIG and HFMA jointly reported that over 17% of digestive-system denials result from incorrect ICD-10 chapter sequencing. PROMBS’ AI-powered audit engine eliminates such risks by verifying every ICD-10 Code for Cirrhosis of Liver claim against its proper ICD-10 hierarchy, ensuring compliance with CMS and AHIMA chapter classification standards before submission.
Which CPT codes pair with the ICD-10 code for cirrhosis of liver?
Accurate CPT–ICD linkage is essential for proper reimbursement and compliance when billing the ICD-10 Code for Cirrhosis of Liver (K74.60). Each procedure or diagnostic test associated with cirrhosis such as imaging, lab work, or paracentesis must demonstrate medical necessity through explicit linkage with the diagnosis code. The Centers for Medicare & Medicaid Services (CMS) enforces strict National Correct Coding Initiative (NCCI) edits to ensure procedures billed under K74.60 correspond with documented findings. The American Academy of Professional Coders (AAPC) and American Health Information Management Association (AHIMA) emphasize that cirrhosis care often involves multidisciplinary testing ranging from hepatic panels to endoscopic procedures and that coders must map each CPT code accurately to avoid “medical necessity” denials. PROMBS integrates this precision into its claim-auditing system, verifying that every CPT code linked with K74.60 meets payer criteria and OIG documentation requirements.
| CPT Code | Procedure Description | Compliance Insight |
|---|---|---|
| 80076 | Hepatic function panel | CMS lists this as the most common lab test tied to K74.60 for monitoring liver function and enzyme levels. |
| 49083 | Therapeutic paracentesis with imaging guidance | AHIMA confirms that this CPT requires linkage to K74.60 when performed for ascites due to cirrhosis. |
| 76705 | Ultrasound, abdomen, limited | HHS notes this imaging code validates medical necessity when assessing hepatic structure and ascitic fluid. |
| 43235 | Upper GI endoscopy for variceal screening | The OIG mandates documentation of variceal evaluation for cirrhotic patients with portal hypertension. |
| 99214 / 99215 | Established patient visit (in-person or telehealth) | HFMA advises linking these E/M visits to K74.60 for chronic disease management and medication adjustment under POS 10 Telehealth Guide. |
Each CPT code must align precisely with documented cirrhosis findings, such as ascites, variceal bleeding, or hepatic dysfunction. Coders should verify that all diagnostic and therapeutic procedures are clinically linked to the provider’s documented rationale. PROMBS’ CMS-1500 Claim Form Guide automatically validates this connection, ensuring compliance with payer-specific edits and preventing billing discrepancies.
Did You Know?
The Office of Inspector General (OIG) reports that over 20% of gastroenterology claim denials stem from CPT–ICD mismatches or missing medical-necessity documentation. PROMBS’ pre-submission crosswalk validator detects these inconsistencies automatically, confirming that every CPT service attached to the ICD-10 Code for Cirrhosis of Liver meets CMS standards for documentation and reimbursement integrity.
How should documentation be structured to avoid denials for cirrhosis claims?
Even when the correct ICD-10 Code for Cirrhosis of Liver (K74.60) is used, insufficient or inconsistent documentation can lead to payer denials, delayed reimbursements, or compliance audits. The Centers for Medicare & Medicaid Services (CMS) specifies that every cirrhosis-related claim must contain clear clinical evidence including symptom presentation, diagnostic correlation, and treatment rationale to justify medical necessity. The American Health Information Management Association (AHIMA) emphasizes that coders should never assign K74.60 without documented confirmation of cirrhosis through imaging, biopsy, or lab data. Likewise, the Office of Inspector General (OIG) routinely flags liver-related claims for missing etiology, absent provider signatures, and incomplete procedure linkages. PROMBS eliminates these pitfalls using its Denial-Prevention Workflow, an integrated audit model that ensures every claim element CPT, modifier, and documentation is fully compliant before submission.
| Step | Documentation Requirement | Compliance Insight |
|---|---|---|
| 1. Chief Complaint & History | Include fatigue, jaundice, or abdominal swelling as presenting symptoms. | AHIMA confirms that detailed symptom history supports endocrine and hepatic code validation. |
| 2. Diagnostic Evidence | Document imaging results, liver enzymes (ALT, AST), and bilirubin levels. | CMS requires lab and imaging correlation to establish medical necessity for cirrhosis care. |
| 3. CPT–ICD Correlation | Link hepatic panels, ultrasound, and endoscopy CPTs to K74.60. | HFMA identifies incorrect CPT–ICD mapping as a primary reason for GI claim rejections. |
| 4. Modifier Accuracy | Apply modifiers (25, 59) correctly for combined E/M and procedural services. | PROMBS’ Mastering Modifiers 59/25/91 Guide ensures precise modifier use during claim preparation. |
| 5. Treatment Documentation | Record medications, dosages, paracentesis details, and patient response. | HHS mandates comprehensive medication and procedural notes for hepatic care audits. |
| 6. Provider Authentication | Verify date, provider credentials, and electronic signature. | The OIG classifies unsigned or undated notes as non-billable under compliance audits. |
Each step above ensures that cirrhosis-related documentation remains complete, traceable, and audit-proof. Coders should verify that all relevant diagnostic findings, treatments, and CPT services are clearly linked to the diagnosis narrative. PROMBS’ AI-driven compliance module reviews all K74.60 documentation before billing to prevent omissions, ensuring alignment with CMS and HHS audit criteria.
Did You Know?
The OIG found that nearly 19% of cirrhosis claim denials were caused by incomplete documentation or missing provider signatures. PROMBS’ denial-prevention workflow reduces that rate to less than 5% by auditing every ICD-10 Code for Cirrhosis of Liver claim for completeness, medical necessity, and compliance readiness before submission.
Why should providers partner with PROMBS for cirrhosis billing and compliance?
Accurate assignment of the ICD-10 Code for Cirrhosis of Liver (K74.60) requires more than clinical knowledge, it demands precise documentation, compliant CPT linkage, and adherence to evolving federal audit standards. The Centers for Medicare & Medicaid Services (CMS) and Office of Inspector General (OIG) classify liver-disease codes among the highest-risk categories for payment errors and improper documentation. PROMBS eliminates these risks by integrating technology, training, and compliance oversight into every stage of the revenue cycle. PROMBS’ Compliance-First RCM Framework is designed for high-risk specialties like hepatology, gastroenterology, and internal medicine. It automates validation for ICD–CPT alignment, documentation completeness, and medical necessity based on AHIMA and HFMA billing integrity guidelines. Each liver-disease claim, from hepatic panel testing to complex procedures like paracentesis, passes through multiple audit checkpoints before submission.
By combining automation with expert coder review, PROMBS maintains a 97% first-pass claim acceptance rate on cirrhosis-related encounters and ensures 100% traceability during payer or regulatory audits. Our end-to-end approach allows providers to focus on patient care while PROMBS handles every coding, billing, and compliance layer with precision.
Did You Know?
The HFMA reports that hospitals using pre-submission compliance audits reduce denials by over 30% annually. PROMBS integrates such proactive auditing directly into its workflow, meaning every ICD-10 Code for Cirrhosis of Liver claim submitted through our system meets or exceeds documentation and payment-integrity standards defined by CMS, HHS, and OIG.
Partnering with PROMBS ensures that your hepatic billing operations are not only efficient but fully compliant, audit-secure, and financially optimized. From credentialing to claims, PROMBS safeguards every step of your revenue cycle, turning complex liver-disease coding challenges into measurable compliance success.
Frequently asked questions (FAQs)
What is the official ICD-10 code for cirrhosis of liver?
The official ICD-10 Code for Cirrhosis of Liver is K74.60 – Unspecified Cirrhosis of Liver, according to the Centers for Medicare & Medicaid Services (CMS). This code is used when documentation confirms cirrhosis but does not identify its specific cause (alcoholic, biliary, or post-necrotic). The American Health Information Management Association (AHIMA) clarifies that K74.60 should only be assigned if the provider explicitly documents “cirrhosis” without etiology.
Can K74.60 be billed for both inpatient and outpatient encounters?
Yes. CMS permits the use of K74.60 for both inpatient and outpatient settings, as long as medical necessity is established through documented liver dysfunction and related lab results. The Healthcare Financial Management Association (HFMA) recommends coders link hepatic panel CPT 80076 or ultrasound CPT 76705 with K74.60 for accurate claim validation. PROMBS’ EHR-integrated audit engine checks this linkage automatically before submission.
What are the most common CPT codes paired with the ICD-10 code K74.60?
Common pairings include 80076 (Hepatic Function Panel), 49083 (Paracentesis with imaging guidance), 76705 (Abdominal Ultrasound), and 99214/99215 (Follow-up Visits), according to AAPC and CMS. Each CPT must be supported by documentation of symptoms, lab findings, or procedural results. PROMBS’ CMS-1500 Claim Form Guide ensures each CPT–ICD pairing meets payer edit requirements.
Can the ICD-10 code for cirrhosis of liver be used for telehealth services?
Yes. The CMS recognizes K74.60 under Place of Service 10 for virtual visits if the documentation includes relevant findings such as ascites, lab results, and medication management. The Office of Inspector General (OIG) warns that telehealth denials often occur due to incomplete documentation of clinical review. PROMBS’ POS 10 Telehealth Guide ensures full compliance for virtual hepatic care.
What are the top reasons for denial of cirrhosis-related claims?
According to OIG and HFMA, the most common reasons include:
- Missing linkage between CPT and ICD-10 codes
- Absent documentation of ascites or hepatic findings
- Lack of provider authentication or signature
PROMBS’ Denial-Prevention Workflow identifies these deficiencies during pre-bill review, ensuring every ICD-10 Code for Cirrhosis of Liver claim meets CMS and HHS audit standards.
How should documentation support the ICD-10 code K74.60?
AHIMA mandates that documentation must include liver imaging, lab confirmation (ALT, AST, bilirubin), and notation of underlying causes or complications. CMS requires linking these findings to CPTs such as 80076 or 49083. PROMBS’ automated EHR audit ensures that symptom narratives, lab data, and procedure codes align with each K74.60 claim before submission.
Can multiple liver-related diagnoses be billed along with K74.60?
Yes, when clinically justified. AHIMA allows combination coding such as K74.60 with K70.31 (Alcoholic Cirrhosis with Ascites) or B18.2 (Chronic Hepatitis C) if documented. PROMBS’ AI-based compliance validator automatically checks for correct sequencing and ensures dual codes follow CMS and OIG rules.
Does K74.60 qualify for Hierarchical Condition Category (HCC) risk adjustment?
Yes. The CMS Risk Adjustment Model classifies cirrhosis under HCC Category 25 (Chronic Liver Disease and Cirrhosis). Proper documentation directly influences payer reimbursement and population-health scoring. PROMBS’ compliance analytics ensure every ICD-10 Code for Cirrhosis of Liver entry meets HCC documentation standards for accurate risk-weight capture and audit integrity.
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