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v1.0.0
ICD-10 Guide
ICD-10 CodesK74.4

K74.4

Billable

Secondary biliary cirrhosis

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

Code Description

ICD-10 K74.4 is a billable code used to indicate a diagnosis of secondary biliary cirrhosis.

Key Diagnostic Point:

Secondary biliary cirrhosis (K74.4) is a liver condition characterized by the progressive scarring (fibrosis) of the liver due to prolonged obstruction of the bile ducts. This obstruction can arise from various causes, including gallstones, strictures, or tumors that impede bile flow. Clinically, patients may present with symptoms such as jaundice, pruritus, abdominal pain, and fatigue. The anatomy involved primarily includes the liver and biliary system, where bile produced by the liver is stored in the gallbladder and transported through the bile ducts. Over time, the continued obstruction leads to increased pressure in the bile ducts, resulting in liver cell damage and eventual cirrhosis. Diagnostic considerations for K74.4 include imaging studies such as ultrasound, CT scans, or MRCP to identify the cause of bile duct obstruction, along with liver function tests to assess the extent of liver damage. A liver biopsy may also be performed to confirm the diagnosis and evaluate the degree of fibrosis.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and possibly invasive procedures for confirmation.
  • Treatment complexity: Management may involve addressing the underlying cause of obstruction, which can vary widely.
  • Documentation requirements: Detailed clinical history and diagnostic findings are essential for accurate coding.
  • Coding specificity: Must differentiate from other types of cirrhosis and liver diseases.

Audit Risk Factors

  • Common coding errors: Misclassification with primary biliary cirrhosis (K74.3) or other liver diseases.
  • Documentation gaps: Lack of detailed descriptions of the underlying cause of biliary obstruction.
  • Billing challenges: Potential denials if documentation does not clearly support the diagnosis of secondary biliary cirrhosis.

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Secondary biliary cirrhosis has significant clinical implications, as it can lead to liver failure and necessitate liver transplantation in severe cases. The condition affects a diverse population, often linked to underlying diseases such as cholestasis or malignancies. Understanding the epidemiology of secondary biliary cirrhosis aids in identifying at-risk populations and improving early detection and management strategies, ultimately enhancing patient outcomes and healthcare resource utilization.

ICD-9 vs ICD-10

Secondary biliary cirrhosis has significant clinical implications, as it can lead to liver failure and necessitate liver transplantation in severe cases. The condition affects a diverse population, often linked to underlying diseases such as cholestasis or malignancies. Understanding the epidemiology of secondary biliary cirrhosis aids in identifying at-risk populations and improving early detection and management strategies, ultimately enhancing patient outcomes and healthcare resource utilization.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the medical necessity for diagnostic imaging and any procedures performed is clearly documented. Common denials may arise from insufficient documentation linking the diagnosis to the treatment provided. Best practices include maintaining detailed clinical notes and ensuring that all relevant diagnostic tests are coded accurately to support the claim.

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 K74.4?

K74.4 encompasses cirrhosis resulting from secondary causes of biliary obstruction, including but not limited to gallstones, strictures, and malignancies affecting the bile ducts.

When should K74.4 be used instead of related codes?

K74.4 should be used when cirrhosis is specifically due to secondary biliary obstruction, as opposed to primary biliary cirrhosis (K74.3) or cirrhosis due to other etiologies.

What documentation supports K74.4?

Documentation should include clinical findings, imaging results indicating bile duct obstruction, liver function test results, and any relevant history of biliary disease or interventions.