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v1.0.0
ICD-10 Guide
ICD-10 CodesK74.3

K74.3

Billable

Primary biliary cirrhosis

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 K74.3 is a billable code used to indicate a diagnosis of primary biliary cirrhosis.

Key Diagnostic Point:

Primary biliary cirrhosis (PBC), now more commonly referred to as primary biliary cholangitis, is a chronic autoimmune liver disease characterized by the progressive destruction of the small bile ducts within the liver. This condition leads to cholestasis, fibrosis, and ultimately cirrhosis. Clinically, patients may present with fatigue, pruritus, and jaundice, often accompanied by elevated alkaline phosphatase levels. The disease predominantly affects middle-aged women and is associated with other autoimmune disorders such as Sjögren's syndrome and rheumatoid arthritis. As the disease progresses, patients may develop complications related to cirrhosis, including portal hypertension and liver failure. Diagnosis typically involves serological tests for antimitochondrial antibodies (AMA) and liver biopsy to assess the degree of fibrosis. Imaging studies may also be utilized to evaluate bile duct patency and liver architecture. Early diagnosis and management are crucial to slow disease progression and improve quality of life.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires specific serological tests and possibly liver biopsy.
  • Treatment complexity: Management may include medications such as ursodeoxycholic acid and monitoring for complications.
  • Documentation requirements: Detailed clinical history and lab results are essential for accurate coding.
  • Coding specificity: Requires precise coding to differentiate from other liver diseases.

Audit Risk Factors

  • Common coding errors: Misclassification with other liver diseases.
  • Documentation gaps: Lack of comprehensive lab results or clinical notes.
  • Billing challenges: Potential denials due to insufficient documentation of the autoimmune nature.

Specialty Focus

Medical Specialties

Gastroenterology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Hepatology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Primary biliary cirrhosis significantly impacts patient quality of life and healthcare utilization, often leading to increased medical visits and potential liver transplantation in advanced cases. The condition affects a notable portion of the population, particularly women aged 40-60, highlighting the need for awareness and early intervention. Epidemiologically, PBC is associated with other autoimmune diseases, which can complicate management and increase healthcare costs.

ICD-9 vs ICD-10

Primary biliary cirrhosis significantly impacts patient quality of life and healthcare utilization, often leading to increased medical visits and potential liver transplantation in advanced cases. The condition affects a notable portion of the population, particularly women aged 40-60, highlighting the need for awareness and early intervention. Epidemiologically, PBC is associated with other autoimmune diseases, which can complicate management and increase healthcare costs.

Reimbursement & Billing Impact

Reimbursement considerations include the need for prior authorization for certain treatments and potential denials if documentation does not clearly support the diagnosis. Common challenges include ensuring that all relevant tests and procedures are coded correctly to reflect the complexity of the condition. Coders should be aware of payer-specific guidelines and ensure that all documentation aligns with the services billed.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for K00-K99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for K00-K99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by K74.3?

K74.3 specifically covers primary biliary cirrhosis, characterized by autoimmune destruction of bile ducts, leading to cholestasis and liver damage. It is important to differentiate it from secondary biliary cirrhosis and other liver diseases.

When should K74.3 be used instead of related codes?

K74.3 should be used when the diagnosis of primary biliary cirrhosis is confirmed through serological testing for AMA and clinical presentation. It should not be used for other forms of cirrhosis or liver disease without autoimmune features.

What documentation supports K74.3?

Documentation for K74.3 should include clinical findings, laboratory results indicating elevated alkaline phosphatase and positive AMA, and any imaging studies performed. A liver biopsy report may also be necessary to confirm the diagnosis.