# Best code(s) for ESLD due to alcoholic cirrhosis?



## lynnmcd (Apr 4, 2018)

Hi all!

I am probably over thinking this one. As stated above, the doc gave this patient a primary dx of end stage liver disease DUE TO alcoholic cirrhosis of the liver. The active dx list at the time of admission to our program include both chronic hepatic failure, and the alcoholic cirrhosis with ascites as two separate things, nothing end stage, This is the docs primary after review.

So? K70.31? K70.40 (there is no coma) with implied cirrhosis and ascites?  Separate codes for the cirrhosis and ascites? (We are a hospice and so there will not be fix-it treatments done but sometimes we do drain ascites as a comfort measure so I think we need to capture this. I could be wrong.)

Anything else I am missing?  My head is swimming.

Thanks! 

Lynn


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## rhondatalley (Apr 4, 2018)

K70.40 for the liver failure due to alcoholic cirrhosis w/o coma and K70.31 for alcoholic cirrhosis with ascites



lynnmcd said:


> Hi all!
> 
> I am probably over thinking this one. As stated above, the doc gave this patient a primary dx of end stage liver disease DUE TO alcoholic cirrhosis of the liver. The active dx list at the time of admission to our program include both chronic hepatic failure, and the alcoholic cirrhosis with ascites as two separate things, nothing end stage, This is the docs primary after review.
> 
> ...


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## lynnmcd (Apr 4, 2018)

rhondatalley said:


> K70.40 for the liver failure due to alcoholic cirrhosis w/o coma and K70.31 for alcoholic cirrhosis with ascites



Well I'll be darned!   That's what I thought but kept thinking I was not able to apply two K70 codes.  I have no idea why but those guidelines are so scary and I was sure some lightening bolt was going to smack me upside the head if I did that!

Thanks, Rhonda!


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## Rajesh1 (Apr 5, 2018)

*Esld*

Hi,


End-stage Liver Disease (ESLD) Chronic liver failure, also called end-stage liver disease, progresses over months, years, or decades. Most often, chronic liver failure is the result of cirrhosis, a condition in which scar tissue replaces healthy liver tissue until the liver cannot function adequately

Liver cirrhosis end stage is liver failure hence need not to code Cirrhosis 

Codes need to be assigned 

K70.40 and Followed by F10 series codes  

Thank you 

Rajesh Kalaka 
CPC,RN


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## lynnmcd (Apr 5, 2018)

Thanks, Rajesh.

I found this this morning from an article in a 2016 issue of the Diagnostic Coding Pro in which they did a highlight on this very topic:

"Code both end-stage liver disease (K72.90) and cirrhosis (K74.60)
if a patient has been diagnosed with both conditions or you’ll be
submitting incomplete Medicare claims that don’t accurately reflect
the patient’s condition.

It’s necessary to include both conditions if both have been
diagnosed because not all patients who have end-stage liver
disease also have cirrhosis, says Brandi Whitemyer, HCS-D, product
specialist for DecisionHealth in Gaithersburg, Md."

So it is necessary to code for both using the K70 codes (as alcohol as the precipitating factor has been expressed) as noted above in the thread. Since the only thing the doctor put down for the alcohol usage was the statement, "...continues to consume alcohol." without any referring words like "abuse" or "dependence" my F10 code will just have to be generic.

So, in my scenario I am going to go with these codes in this sequence: K70.40, K70.31, F10.988


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