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ICD-10 Guide
ICD-10 CodesR94.5

R94.5

Abnormal results of liver function studies

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 R94.5 is a billable code used to indicate a diagnosis of abnormal results of liver function studies.

Key Diagnostic Point:

Abnormal results of liver function studies (R94.5) indicate deviations from normal values in tests that assess the liver's ability to perform its functions, including the production of proteins, the metabolism of substances, and the detoxification of harmful compounds. Common liver function tests include serum aminotransferases (ALT and AST), alkaline phosphatase, bilirubin levels, and albumin. Abnormal results may suggest liver disease, bile duct obstruction, or other systemic conditions affecting liver function. Symptoms associated with abnormal liver function may include jaundice, fatigue, abdominal pain, and changes in urine or stool color. It is crucial to interpret these results in the context of the patient's clinical history and other diagnostic findings to determine the underlying cause and appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential underlying causes (e.g., hepatitis, cirrhosis, drug-induced liver injury)
  • Need for correlation with clinical symptoms and history
  • Potential for overlapping symptoms with other conditions
  • Variability in laboratory reference ranges

Audit Risk Factors

  • Inadequate documentation of clinical rationale for testing
  • Failure to link abnormal results to specific diagnoses
  • Misinterpretation of lab results leading to incorrect coding
  • Lack of follow-up documentation on abnormal findings

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed patient history, rationale for testing, and follow-up plans must be documented.

Common Clinical Scenarios

Routine check-ups revealing elevated liver enzymes, patients with chronic liver disease undergoing monitoring.

Billing Considerations

Consideration of comorbidities that may affect liver function and the need for comprehensive documentation.

Emergency Medicine

Documentation Requirements

Acute presentation documentation, including symptoms, lab results, and immediate management plans.

Common Clinical Scenarios

Patients presenting with acute abdominal pain and abnormal liver function tests.

Billing Considerations

Rapid assessment and documentation of potential acute liver failure or other urgent conditions.

Coding Guidelines

Inclusion Criteria

Use R94.5 When
  • Follow official ICD
  • CM guidelines for coding and reporting, ensuring that the abnormal results are documented and linked to the clinical context
  • Ensure that the results are not coded in isolation without a corresponding diagnosis

Exclusion Criteria

Do NOT use R94.5 When
No specific exclusions found.

Related CPT Codes

80076CPT Code

Liver function panel

Clinical Scenario

Used when liver function tests are ordered as part of a routine evaluation.

Documentation Requirements

Document the reason for the liver function panel and any relevant clinical history.

Specialty Considerations

Internal medicine and gastroenterology often order these panels for monitoring liver health.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of liver function abnormalities, improving the ability to capture the nuances of liver disease and its management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of liver function abnormalities, improving the ability to capture the nuances of liver disease and its management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of liver function abnormalities, improving the ability to capture the nuances of liver disease and its management.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What should I document when coding R94.5?

Document the patient's clinical history, the reason for the liver function tests, the results, and any follow-up actions taken. Ensure that the abnormal results are linked to the patient's clinical condition.