Coding, Classification and Reimbursement

Liver Failure

  • 1.  Liver Failure

    Posted 11-25-2018 13:34
    I could use some help coding acute liver failure.
    Pt. admitted for alcohol detox, depression and SI. His medical history include cirrhosis, hepatitis (patient does not remember if it is A, B, or C), fatigue. He had withdrawals first few days and complained of feeling weak and tired.
    Third day his labs came back abnormal and he was bleeding from gums. Sent to ER and came back.
    Following day pt. was actively bleeding from mouth, large amounts of blood, had blood in urine, jaundice, confusion (hard to understand and could not provide any basic info to physician), and slightly enlarged liver. Labs were even more abnormal that previous ones.
    Medical team believe it is acute liver failure, medically decompensating.
    DX thrombocytopenia, hyperbiliruberia, confusion likely due to ammonia levels, and bleeding (oral and urine)

    Liver failure or cirrhosis are not tied to the alcohol.
    I am not sure what is considered part of acute liver failure.
    Here's what I have so far:
    F10.239 - Alcohol dependence w/withdrawal
    K72.00 Acute, subacute hepatic failure w/o coma
    F33.2 MDD
    R45.851 SI
    E72.20 Disorder of urea cycle metabolism (high ammonia levels)
    D69.6 Thrombocytopenia
    K13.79 Other lesions of oral mucosa
    K74.60 Unspecified cirrhosis of liver
    K73.9 Chronic hepatitis, unps
    R31.9 hematuria, unspecified
    R17 Jaundice

    But the code K72.00 Acute of subacute liver failure includes acute non-viral hepatitis NOS, so I don't know if I should use K72.90 instead?
    I know that the jaundice is part of elevated bilirubin, but is that part of liver failure? What about the ammonia levels?
    Hemorrhage – mouth send me to K13.79 Other lesions of oral mucosa. But I don't really like that code.

    Theresa Guerra, RHIT
    HIM Coder

  • 2.  RE: Liver Failure

    Posted 11-26-2018 11:50
    The Merck Manual is a wonderful reference tool as it describes the disease process.  This provides the various components and will help you decide what codes to include.  IT is included in the Optum360 CAC and 3M encoder software, but can purchased in book form and Barnes & Noble.

    For example, jaundice is a part of liver failure and would not be coded separately.  The bleeding is likely due to they hypercoagulopathy from the liver disease (needs to be linked) and would be coded as secondary thrombocytopenia - D69.49.

    Carol Nickels, RHIA, CCS
    Coding and Documentation Review Consultant
    Kaiser Permanente - Regional Offices (Oakland, CA)