Coding for liver diseases is a significant aspect in gastroenterology medical billing and coding. Medical News Today recently reported on a new study published in the journal Gut, confirms what earlier research found – that high body mass index (BMI), which indicates obesity, is linked to severe liver disease in later life. When reporting a primary condition with comorbidities, proper physician documentation and use of the right ICD-10 and CPT codes is necessary to provide evidence of severity and medical necessity, improve multidisciplinary care, and ensure appropriate reimbursement.
According to the Centers for Disease Control and Prevention (CDC), more than one-third (35.7 percent) of U.S. adults are obese. The American Liver Foundation reports that up to 25 percent of people in the U.S. are living with NAFLD. In addition to various other medical conditions, obesity in youth can lead to liver diseases such as chronic viral hepatitis B and C, as well as non-alcoholic liver disease.
Researchers from the Centre for Digestive Diseases at the Karolinska University Hospital in Sweden conducted an in-depth study of the link between BMI and liver disease. The research was based on data from 1.2 million Swedish men who were conscripted into the army from 1969 to 1996 as well as from population-based registers charting liver cancer, severe liver disease, and type 2 diabetes. Men who received a diagnosis of alcoholic liver disease during follow-up were not included in the study.
Following the participants from 1 year after conscription, up until the end of 2012, the team analyzed up to 34 million person-years. Their findings are as follows:
- 5,281 cases of severe liver disease, including 251 cases of liver cancer
- Compared to men of normal weight, overweight men faced an almost 50 percent increase in risk of liver disease in later life
- Obese men were more than twice as likely to develop liver disease as they got older
- Participants with both obesity and type 2 diabetes were more than three times more likely to develop liver problems as they aged
The researchers recommend earlier interventions and additional screening for those at risk, which brings us to diagnostic coding for obesity and liver disease.
When a patient is evaluated for obesity, the physician also evaluates comorbidity conditions that are being treated or that affect the treatment. In this case, liver disease is the comorbidity and therefore the additional diagnoses code should be reported for this condition evaluated that affected the current visit, linked to the appropriate evaluation and management (CPT) code. Diagnosis-related groups (DRGs) should be used to identify related conditions that may affect a patient’s care and which are linked to reimbursement. Likewise, reimbursement for professional services should be reported using appropriate CPT procedure codes.
The primary diagnosis code (primary reason for the visit) is used for the visit, as the first linked diagnosis. Comorbidities affecting the patient’s obesity assessment, evaluation, or treatment that also are evaluated are reported as secondary codes.
In ICD-10-CM, overweight and obesity codes come in category E66. Code E66.3 is used to report overweight. The codes for obesity are: E66.0- due to excess calories; E66.1 if drug-induced; E66.2 with alveolar hypoventilation; E66.8 due to other specified causes, or E66.9, (unspecified).
K70-77 are the diagnostic codes for liver diseases in ICD-10:
- K70, Alcoholic liver disease
- K71, Toxic liver disease
- K72, Hepatic failure, not elsewhere classified
- K73, Chronic hepatitis, not elsewhere classified
- K74, Fibrosis and cirrhosis of liver
- K75, Other inflammatory liver diseases
- K76, Other diseases of liver
- K77, Liver disorders in diseases classified elsewhere
Nonalcoholic fatty liver disease refers to a wide spectrum of liver disease, ranging from simple fatty liver (steatosis) to nonalcoholic steatohepatitis, and finally cirrhosis.
K76.0 is the 2017 ICD-10-CM Diagnosis Code for nonalcoholic fatty liver disease (NAFLD).
ICD-10-CM K76.0 is grouped within Diagnostic Related Group(s) (MS-DRG v34.0):
441 Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCC
442 Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CC
443 Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without CC/MCC
Due to ICD-10-CM specificity, most of the diagnosis code sections have multiple codes for particular conditions. There are 115 ICD-10-CM codes grouped within the above 3 MS-DRG groups.
Coding to the highest degree of specificity and to the highest degree of certainty for proper reimbursement is much easier with outsourced medical billing and coding services. Based on physician documentation, expert AAPC-certified codes will link the diagnosis codes to the procedure codes (CPT) on claims, sequence the reporting correctly and code only diagnoses relevant for the current encounter. Such support is vital to ensure consistency with the latest coding conventions and guidelines, prevent claim rejections, and maximize revenue.