Liver failure w/wo hepatic encephalopathy, acute or subacute NOS
|Dx:||Liver failure w/wo hepatic encephalopathy, acute or subacute NOS|
|Pre-ICD10 counterpart:||Fulminant Hepatic Failure, Non Fulminant Hepatic Failure|
|Charlson/ALERT Scale:||Moderate or severe liver disease|
|APACHE Como Component:||Liver|
|APACHE Acute Component:||none|
|External ICD10 Documentation|
- This is the code to use for fulminant OR acute OR subacute liver failure (with or without hepatic encephalopathy) that is NOT due to ethanol or another drug/toxin.
- It includes liver failure due to: shock liver, viral infection, autoimmune, etc -- as long as the time course is fulminant or acute or subacute
- Also code the cause of the liver failure, if known (e.g. shock)
- See the article Shock liver in ICD10 for how to code that entity.
- Remember that liver failure is a distinct manifestation of advanced liver disease that can be caused by many different types of liver disease. Elevations (even big elevations) alone of transaminases is not liver failure. In liver failure, there must be evidence of one or both of:
- synthetic dysfunction indicated by coagulopathy (with elevated PT, INR), very low albumin and other plasma proteins
- hepatic encephalopathy
- Liver cirrhosis is NOT the same thing as liver failure. They can occur alone, or together.
- Cirrhosis rarely has time to develop in fulminant or acute or even subacute liver failure.
DEFINITION — Fulminant hepatic failure refers to the rapid development of severe liver injury resulting in impaired function and encephalopathy in a person who previously had a normal liver or had well-compensated liver disease. Several definitions of the time course for which liver failure should be considered fulminant have been proposed but are not standard:
- The development of encephalopathy within eight weeks of the onset of symptoms in a patient with a previously healthy liver.
- The appearance of encephalopathy within two weeks of developing jaundice, even in a patient with previous underlying liver dysfunction.
- Patients who have rapid deterioration of liver function with the development of encephalopathy within six months but fall outside the boundaries of the above time intervals are considered to have "subfulminant" hepatic failure.
Fulminant liver failure (FLF), is a rare condition in which rapid deterioration of liver function results in altered mentation and coagulopathy in previously normal individuals. U.S. estimates are placed at approximately 2,000 cases per year. The most prominent causes include drug-induced liver injury, viral hepatitis, autoimmune liver disease, and shock or hypoperfusion; many cases (20 percent) have no discernible cause. Fulminant liver failure often affects young persons and carries a high morbidity and mortality. Prior to transplantation, most series suggested less than 15 percent survival. Currently, overall short-term survival with transplantation is greater than 65 percent. Because of its rarity, FLF has been difficult to study in depth and very few controlled therapy trials have been performed. As a result, standards of intensive care for this condition have not been established. Non Fulminant Hepatic failure - refers to liver failure that has been on a steady decline. End of the line due to a chronic underlying know liver disease.
- Subacute hepatic failure (SAHF) is now recognized as distinct disease with characteristics of progressive hepatic failure defined by clinical and biochemical criteria . There has been lot of controversy regarding the time frame by which hepatic failure occurs as well as clinical features particularly presence of encephalopathy . Acute liver failure is characterized by onset of encephalopathy within 8 weeks of appearance of jaundice where as chronic liver failure is defined as hepatic decompensation occuring 24 weeks after the onset of liver disease. SAHF is now characterized by gradual deterioration of hepatic function between 8 and 24 weeks of onset of jaundice.
Altered mental status
Coding altered mental status in ICD10 can be complex, see ICD10 Guideline for coding altered mental status for more info.
Alternate ICD10s to consider coding instead or in addition
|Liver failure codes:|
Candidate Combined ICD10 codes
Code the cause if known, e.g. shock liver, Hep B, Hep C, other viral hepatitis, immune-mediated liver diseases, or other causes of liver disease
- Hepatitis B, acute
- Hepatitis C, acute
- Viral hepatitis, acute, NOS
- Hepatitis B, chronic
- Hepatitis C, chronic
- Viral hepatitis, chronic, NOS
- Hepatitis A, acute
- Hepatitis, autoimmune
Related CCI Codes
Data Integrity Checks (SMW)