Cirrhosis refers to the severe scarring (fibrosis) and poor functioning of the liver, normally visible at the terminal stages of a chronic liver disease. According to the National Institutes of Health (NIH), liver cirrhosis is the 12th leading cause of death due to disease in the United States. It is estimated that the condition more commonly affects men than women. In most cases, the scarring of the liver is caused by long-term exposure to toxins like alcohol or viral infections. Cirrhosis develops when the factors that damage the liver are present over a long period of time. Each time the liver gets injured, it tries to repair by itself and this results in the formation of scar tissue. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function by itself. Liver damage caused by cirrhosis cannot be controlled or undone. However, if diagnosed at an early stage, further damage can be effectively controlled or reversed. Medications and positive lifestyle habits can help reduce the symptoms to some extent. When medications and other treatment options fail to give the desired results, physicians may recommend liver transplantation as a last resort. As reimbursement rules, regulations, and payer policies are subject to frequent changes, partnering with an experienced medical billing and coding company is the best option to ensure correct claims for accurate reimbursement.

Cirrhosis causes the liver to shrink and harden, which makes it difficult for nutrient-rich blood to flow into the liver from the portal vein. Generally, a wide range of diseases and conditions can damage the liver and lead to cirrhosis. Long-term viral hepatitis infection and chronic alcohol abuse are the most common causes of cirrhosis in the United States. Reports from the National Institutes of Health (NIH) suggest that cirrhosis can develop in women who drink more than two alcoholic drinks per day for many years. Men who drink more than three drinks a day for years are at high risk for cirrhosis. However, this doesn’t mean that everyone who has ever drunk more than a few drinks could develop cirrhosis over the course of time. Cirrhosis caused by alcohol is usually the result of regular alcohol intake (more than these amounts) over the course of 10 or 12 years. Other related causes include – fat accumulating in the liver (nonalcoholic fatty liver disease), iron buildup in the body (hemochromatosis), cystic fibrosis, biliary atresia, genetic digestive disorder, destruction of the bile ducts and use of medications ( like methotrexate or isoniazid).

Liver Cirrhosis – Symptoms

Cirrhosis occurs when the liver is unable to purify the blood, break down toxins and produce clotting proteins. In most cases, the signs and symptoms of cirrhosis develop when the liver damage is extensive. Some of the common symptoms associated with the condition include –

  • Decreased appetite
  • Jaundice
  • Weight loss
  • Swelling in your legs, feet or ankles (edema)
  • Spiderlike blood vessels on your skin
  • Small spider-shaped arteries underneath the skin
  • Redness in the palms of the hands
  • Nausea and weakness
  • Loss of sex drive, breast enlargement (gynecomastia) or testicular atrophy (for men)
  • Itchy skin
  • Fluid accumulation in your abdomen (ascites)
  • Easily bleeding or bruising
  • Anorexia
  • Absent or loss of periods not related to menopause (for women)

If not diagnosed at an early stage or left untreated, it can cause several complications like – high blood pressure in the veins (portal hypertension), swelling in the legs and abdomen, bleeding, infections, buildup of toxins in the brain (hepatic encephalopathy), enlargement of the spleen (splenomegaly) and increased risk of liver cancer.

How is Liver Cirrhosis Diagnosed and Treated?

Generally, people with early-stage cirrhosis of the liver don’t have any specific symptoms. Diagnosis of the condition, in most cases, begins with a detailed medical history review and physical examination. Medical history evaluation may involve analysis of details such as long-term alcohol abuse, exposure to hepatitis C, family history of autoimmune diseases and other risk factors. Cirrhosis is first detected through a routine blood test or checkup. To help confirm a diagnosis, a combination of laboratory and imaging tests will be done which help evaluate the extent of liver damage. Some of the tests used for evaluation of cirrhosis include complete blood count (to reveal anemia), liver function tests, coagulation blood tests (to see how quickly blood clots), alpha fetoprotein (a liver cancer screening) and albumin (to test for a protein produced in the liver). In addition, imaging tests like ultrasound scan of the liver, MRI and CT scan of the abdomen, Magnetic resonance elastography (MRE) and upper endoscopy (to see if esophageal varices are present) will be performed to evaluate the hardening of the liver. In some cases, liver biopsy (a tissue sample for diagnosis) will be done to identify the severity, extent and cause of liver damage.

Treatment for liver cirrhosis varies and depends on the specific causes and progression of liver damage. Treatment modalities aim to slow the progression of scar tissue in the liver, and prevent or treat symptoms and complications in a better manner. In early stage cirrhosis, it may be possible to minimize damage to the liver by treating the underlying cause. Treatment may focus on reducing alcohol dependency, reducing body weight, and medications (beta blockers or nitrates) to control symptoms of hepatitis. Other treatment procedures include – banding procedures (used to control bleeding from esophageal varices), intravenous antibiotics and hemodialysis (to purify the blood of those in kidney failure). In advanced cases of cirrhosis, when the liver ceases to function, a liver transplant may be the last treatment option. Liver transplantation helps replace the liver with a healthy liver from a deceased donor or with part of a liver from a living donor.

General surgery medical coding involves using the specific ICD-10 diagnosis codes, CPT procedure codes for reporting cirrhosis of liver on your medical claims.

ICD-10 Codes for Liver Cirrhosis

  • K74 Fibrosis and cirrhosis of liver
  • K74.0 Hepatic fibrosis
    • K74.00 Hepatic fibrosis, unspecified
    • K74.01 Hepatic fibrosis, early fibrosis
    • K74.02 Hepatic fibrosis, advanced fibrosis
  • K74.1 Hepatic sclerosis
  • K74.2 Hepatic fibrosis with hepatic sclerosis
  • K74.3 Primary biliary cirrhosis
  • K74.4 Secondary biliary cirrhosis
  • K74.5 Biliary cirrhosis, unspecified
  • K74.6 Other and unspecified cirrhosis of liver
    • K74.60 Unspecified cirrhosis of liver
    • K74.69 Other cirrhosis of liver

CPT Codes

  • 47133 Donor hepatectomy (including cold preservation), from cadaver donor
  • 47135 Liver allotransplantation, orthotopic, partial or whole, from cadaver or living donor, any age
  • 47140 Donor hepatectomy (including cold preservation), from living donor; left lateral segment only (segments II and III)
  • 47141 Donor hepatectomy (including cold preservation), from living donor; total left lobectomy (segments II, III and IV)
  • 47142 Donor hepatectomy (including cold preservation), from living donor; total right lobectomy (segments V, VI, VII and VIII)
  • 47143 Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; without trisegment or lobe split
  • 47144 Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; with trisegment split of whole liver graft into 2 partial liver grafts (i.e., left lateral segment [segments II and III] and right trisegment [segments I and IV through VIII])
  • 47145 Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; with lobe split of whole liver graft into 2 partial liver grafts (i.e., left lobe [segments II, III, and IV] and right lobe [segments I and V through VIII])
  • 47146 Backbench reconstruction of cadaver or living donor liver graft prior to allotransplantation; venous anastomosis, each
  • 47147 Backbench reconstruction of cadaver or living donor liver graft prior to allotransplantation; arterial anastomosis, each
  • 47399 Unlisted procedure, liver

Quitting alcohol consumption, eating a balanced diet, getting adequate exercise, maintaining a healthy body weight, and reducing the risk of hepatitis can help prevent or slow the progression of cirrhosis. The World Health Organization reports that only 20 to 30 percent of people infected with hepatitis B will develop cirrhosis or liver cancer. Life expectancy of people with liver cirrhosis depends on several factors like – cause and severity of cirrhosis, response to treatment modalities, patient age and other existing general health problems.

Medical billing and coding require knowledge regarding the right modifiers and payer-specific medical billing for correct and on-time reimbursement. With all the complexities involved, the support of a reliable and experienced medical coding service provider would prove useful to report liver cirrhosis correctly.