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v1.0.0
ICD-10 Guide
ICD-10 CodesK74.5

K74.5

Billable

Biliary cirrhosis, unspecified

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

Code Description

ICD-10 K74.5 is a billable code used to indicate a diagnosis of biliary cirrhosis, unspecified.

Key Diagnostic Point:

Biliary cirrhosis, unspecified, is a chronic liver disease characterized by progressive destruction of the bile ducts, leading to cholestasis and liver damage. Clinically, patients may present with symptoms such as fatigue, pruritus, jaundice, and abdominal discomfort. The disease primarily affects the liver's anatomy, particularly the bile ducts and hepatocytes, resulting in fibrosis and eventual cirrhosis. Disease progression can lead to complications such as portal hypertension, liver failure, and hepatocellular carcinoma. Diagnostic considerations include liver function tests, imaging studies (such as ultrasound or MRI), and liver biopsy to assess the extent of fibrosis and rule out other liver diseases. The diagnosis is often supported by the presence of autoimmune markers, particularly in cases of primary biliary cholangitis, which is a common cause of biliary cirrhosis. Early detection and management are crucial to slow disease progression and improve patient outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires comprehensive evaluation and differential diagnosis.
  • Treatment complexity: Management may involve medications, lifestyle changes, and potential liver transplantation.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires accurate coding to differentiate from other liver diseases.

Audit Risk Factors

  • Common coding errors: Misclassification with other liver diseases.
  • Documentation gaps: Incomplete clinical notes that do not support the diagnosis.
  • Billing challenges: Potential for denials if documentation does not clearly establish medical necessity.

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

Biliary cirrhosis has significant clinical implications, affecting patient quality of life and leading to increased healthcare utilization due to complications such as liver failure. It is essential for population health management, as early detection and intervention can improve outcomes. The condition is associated with a notable burden on healthcare systems, necessitating effective management strategies to reduce complications and hospitalizations.

ICD-9 vs ICD-10

Biliary cirrhosis has significant clinical implications, affecting patient quality of life and leading to increased healthcare utilization due to complications such as liver failure. It is essential for population health management, as early detection and intervention can improve outcomes. The condition is associated with a notable burden on healthcare systems, necessitating effective management strategies to reduce complications and hospitalizations.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of care provided, the necessity of diagnostic tests, and the potential for complications. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Best practices include ensuring that all clinical notes are complete, accurate, and reflect the patient's condition and treatment plan.

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 K74.5?

K74.5 covers biliary cirrhosis that is not specified as being due to a particular underlying condition, such as primary biliary cholangitis or secondary causes. It is used when the etiology of the cirrhosis is unknown or not documented.

When should K74.5 be used instead of related codes?

K74.5 should be used when biliary cirrhosis is diagnosed but the specific cause is not identified. If the etiology is known, such as autoimmune or secondary causes, more specific codes should be utilized.

What documentation supports K74.5?

Documentation should include clinical findings, laboratory results, imaging studies, and any relevant history that supports the diagnosis of biliary cirrhosis. A clear statement of the diagnosis from the healthcare provider is essential.