Radiology Coding Alert

Watch documentation to find a better option than the ICD-10 NOS code.

When ICD-10-CM replaces ICD-9-CM on Oct. 1, 2013, finding a match for 571.5 (Cirrhosis of liver without alcohol) will take a bit of extra work. While most of the diagnoses you code under ICD-9 will cross directly to a matching ICD-10 code or well-defined range of codes, the corresponding codes for 571.5 aren't as neatly arranged. Here's a closer look at the codes that apply to this diagnosis.

The diagnosis: Cirrhosis refers to scarring of the liver caused by injury or disease. As scar tissue replaces healthy tissue, the liver no longer functions properly. The codes discussed here are specific to cases in which alcohol is not mentioned in relation to the cirrhosis.

ICD-9: The ICD-9 code for this diagnosis applies to a long list of terms with the code:

• 571.5, Cirrhosis of liver without mention of alcohol

Cirrhosis of liver:

NOS

cryptogenic

macronodular

micronodular

posthepatitic

postnecrotic

Healed yellow atrophy (liver)

Portal cirrhosis.

ICD-10: If you check the general equivalency mappings (GEMs) for 571.5, you'll find three ICD-10 codes indicated as potential matches:

• K74.0, Hepatic fibrosis
• K74.60, Unspecified cirrhosis of liver

Cirrhosis (of liver) NOS

• K74.69, Other cirrhosis of liver

Cryptogenic cirrhosis (of liver)

Macronodular cirrhosis (of liver)

Micronodular cirrhosis (of liver)

Mixed type cirrhosis (of liver)

Portal cirrhosis (of liver)

Postnecrotic cirrhosis (of liver).

One of the main differences between the ICD-9 and ICD-10 options is that ICD-10 provides distinct options for cirrhosis NOS (K74.60) and other cirrhosis (K74.69). In contrast, ICD-9 includes all of those diagnoses under 571.5. Another difference is that ICD-10 creates a distinct code for hepatic fibrosis (K74.0). If you search this term in the ICD-9 index, you'll be instructed to also see "cirrhosis, liver," unless the fibrosis is due to Clonorchis sinensis (121.1, Other trematode infection; Clonorchiasis).

Coder tips: Both ICD-9 and ICD-10 instruct you to report an additional viral hepatitis code when appropriate (070.0-070.9 for ICD-9 or B15-B19 for ICD-10).

Documentation: Clear documentation of whether liver cirrhosis is alcohol-related has always been important, and it will continue to be so under ICD-10. But under ICD-10, you'll want to be able to pinpoint whether there's documented confirmation of a particular type of cirrhosis (so you may choose the most specific code) or whether the type remains unspecified (requiring you to report K74.60). Whether coding under ICD-9 now or ICD-10 in the future, look up the documented diagnosis in the index to find the recommended code, and then turn to that code in the tabular to be sure it's the most appropriate one for your case.

Remember: When ICD-10-CM goes into effect on Oct. 1, 2013, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.